Healthcare Provider Details

I. General information

NPI: 1407976202
Provider Name (Legal Business Name): NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E JEFFERSON ST
MACOMB IL
61455-2312
US

IV. Provider business mailing address

301 E JEFFERSON ST
MACOMB IL
61455-2312
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-0160
  • Fax: 815-223-1634
Mailing address:
  • Phone: 815-223-0160
  • Fax: 815-223-1634

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: MR. LARRY BLOCK
Title or Position: VP-FINANCE
Credential: CPA
Phone: 815-223-0160