Healthcare Provider Details

I. General information

NPI: 1407395346
Provider Name (Legal Business Name): BHS PHYSICIAN SERVICES OF ILLINOIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 E 1600 NORTH RD
GILMAN IL
60938-6112
US

IV. Provider business mailing address

160 CHUBB AVE STE 206
LYNDHURST NJ
07071-3526
US

V. Phone/Fax

Practice location:
  • Phone: 844-233-1806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JONATHAN HOREY
Title or Position: PRESIDENT
Credential:
Phone: 646-479-9469