Healthcare Provider Details

I. General information

NPI: 1982366027
Provider Name (Legal Business Name): DUANE DEAN BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 E COURT ST
KANKAKEE IL
60901-4256
US

IV. Provider business mailing address

3942 W NORTH AVE
CHICAGO IL
60647-4639
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-0125
  • Fax: 815-929-1651
Mailing address:
  • Phone: 773-564-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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