Healthcare Provider Details

I. General information

NPI: 1871628362
Provider Name (Legal Business Name): NAPERVILLE PSYCHIATRIC VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

V. Phone/Fax

Practice location:
  • Phone: 630-305-5500
  • Fax:
Mailing address:
  • Phone: 630-305-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number0005058
License Number StateIL

VIII. Authorized Official

Name: MARY LOU MASTRO
Title or Position: PRESIDENT, LOH
Credential:
Phone: 630-305-5001