Healthcare Provider Details

I. General information

NPI: 1235051202
Provider Name (Legal Business Name): AFTERMATH BEHAVIORAL HEALTH IL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 WINDHAM WAY
O FALLON IL
62269-3067
US

IV. Provider business mailing address

1668 WINDHAM WAY
O FALLON IL
62269-3067
US

V. Phone/Fax

Practice location:
  • Phone: 617-435-9783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW GANEM
Title or Position: CEO
Credential:
Phone: 617-435-9783