Healthcare Provider Details

I. General information

NPI: 1295113330
Provider Name (Legal Business Name): VALUE CARE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14127 LEAVITT AVE
BLUE ISLAND IL
60406-3242
US

IV. Provider business mailing address

14127 LEAVITT AVE
BLUE ISLAND IL
60406-3242
US

V. Phone/Fax

Practice location:
  • Phone: 708-566-4950
  • Fax: 708-566-4382
Mailing address:
  • Phone: 708-566-4950
  • Fax: 708-566-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number15001
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number15001
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number15001
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number15001
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number15001
License Number StateIL

VIII. Authorized Official

Name: DR. JERRY WEEMS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PSYD
Phone: 888-205-5532