Healthcare Provider Details

I. General information

NPI: 1841774981
Provider Name (Legal Business Name): JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N RUSH ST
STOCKTON IL
61085-1010
US

IV. Provider business mailing address

PO BOX 813
FREEPORT IL
61032-0813
US

V. Phone/Fax

Practice location:
  • Phone: 815-947-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN MARTINEZ
Title or Position: VP OF PATIENT SERVICES
Credential:
Phone: 815-599-7529