Healthcare Provider Details

I. General information

NPI: 1740455567
Provider Name (Legal Business Name): JMS BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 N CALIFORNIA AVE
CHICAGO IL
60647-2939
US

IV. Provider business mailing address

PO BOX 478920
CHICAGO IL
60647-8920
US

V. Phone/Fax

Practice location:
  • Phone: 773-786-2514
  • Fax:
Mailing address:
  • Phone: 773-786-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE DELIRA
Title or Position: MANAGER
Credential: LCSW
Phone: 773-786-2514