Healthcare Provider Details

I. General information

NPI: 1447549928
Provider Name (Legal Business Name): MENTAL HEALTH AND DEAFNESS RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 SORREL DR
NORTHBROOK IL
60062-2229
US

IV. Provider business mailing address

614 ANTHONY TRL
NORTHBROOK IL
60062-2540
US

V. Phone/Fax

Practice location:
  • Phone: 847-559-0806
  • Fax:
Mailing address:
  • Phone: 847-509-8260
  • Fax: 847-509-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number494988
License Number StateIL

VIII. Authorized Official

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