Healthcare Provider Details

I. General information

NPI: 1114704368
Provider Name (Legal Business Name): NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CHARTRES ST
LA SALLE IL
61301-1097
US

IV. Provider business mailing address

P.O. BOX 1488
LASALLE IL
61301
US

V. Phone/Fax

Practice location:
  • Phone: 815-224-5001
  • Fax:
Mailing address:
  • Phone: 815-224-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LARRY F BLOCK
Title or Position: CONSULTANT
Credential:
Phone: 815-224-5001