Healthcare Provider Details

I. General information

NPI: 1366768772
Provider Name (Legal Business Name): HAWTHORN BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TOWER CT STE C
GURNEE IL
60031-3322
US

IV. Provider business mailing address

PO BOX 6119
VERNON HILLS IL
60061-6119
US

V. Phone/Fax

Practice location:
  • Phone: 847-672-6478
  • Fax:
Mailing address:
  • Phone: 847-672-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: UZOMA OKOLI
Title or Position: OWNER
Credential: MD
Phone: 847-672-6478