Healthcare Provider Details

I. General information

NPI: 1043345119
Provider Name (Legal Business Name): DUANE DEAN BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E COURT ST
KANKAKEE IL
60901-4131
US

IV. Provider business mailing address

700 E COURT ST
KANKAKEE IL
60901-4131
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-0125
  • Fax: 815-939-1249
Mailing address:
  • Phone: 815-939-0125
  • Fax: 815-939-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MR. EDDY BORRAYO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-564-9070