Healthcare Provider Details

I. General information

NPI: 1891887030
Provider Name (Legal Business Name): MENTAL HEALTH AND DEAFNESS RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 ANTHONY TRL
NORTHBROOK IL
60062-2540
US

IV. Provider business mailing address

614 ANTHONY TRL
NORTHBROOK IL
60062-2540
US

V. Phone/Fax

Practice location:
  • Phone: 847-509-8260
  • Fax: 847-509-8157
Mailing address:
  • Phone: 847-509-8260
  • Fax: 847-509-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number381801
License Number StateIL

VIII. Authorized Official

Name: MRS. GAIL FISHER
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-509-8260