Healthcare Provider Details

I. General information

NPI: 1982435657
Provider Name (Legal Business Name): NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST STE NO222
MORRIS IL
60450-1182
US

IV. Provider business mailing address

PO BOX 1488
LA SALLE IL
61301-3488
US

V. Phone/Fax

Practice location:
  • Phone: 815-780-7110
  • Fax:
Mailing address:
  • Phone: 815-780-7110
  • Fax: 815-223-1634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DIANE LYNN GARLAND
Title or Position: CFO
Credential:
Phone: 815-780-7110