Healthcare Provider Details

I. General information

NPI: 1164972246
Provider Name (Legal Business Name): IROQUOIS MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25711 S EGYPTIAN TRL
MONEE IL
60449-8118
US

IV. Provider business mailing address

323 W MULBERRY ST PO BOX 322
WATSEKA IL
60970-1568
US

V. Phone/Fax

Practice location:
  • Phone: 815-432-5241
  • Fax: 815-432-4537
Mailing address:
  • Phone: 815-432-5241
  • Fax: 815-432-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS P. HOPKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 815-432-5241