Healthcare Provider Details

I. General information

NPI: 1841036639
Provider Name (Legal Business Name): PILLARS COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S 6TH STREET APT 1J
LAGRANGE IL
60525
US

IV. Provider business mailing address

5220 EAST AVE
COUNTRYSIDE IL
60525-3133
US

V. Phone/Fax

Practice location:
  • Phone: 708-745-5277
  • Fax:
Mailing address:
  • Phone: 708-745-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA PATEL
Title or Position: VICE PRESIDENT REVENUE CYCLE MANAGE
Credential:
Phone: 708-712-5055