Healthcare Provider Details

I. General information

NPI: 1003022724
Provider Name (Legal Business Name): COMMUNITY MENTAL HEALTH COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8704 S CONSTANCE AVE
CHICAGO IL
60617-2746
US

IV. Provider business mailing address

8704 S CONSTANCE AVE
CHICAGO IL
60617-2746
US

V. Phone/Fax

Practice location:
  • Phone: 773-734-4033
  • Fax: 773-734-6447
Mailing address:
  • Phone: 773-734-4033
  • Fax: 773-734-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL C BELL
Title or Position: CEO
Credential: MD
Phone: 773-734-4033