Healthcare Provider Details

I. General information

NPI: 1366063513
Provider Name (Legal Business Name): JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W EXCHANGE ST
FREEPORT IL
61032-4008
US

IV. Provider business mailing address

PO BOX 813
FREEPORT IL
61032-0813
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE BEHRENDS
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 815-599-7925