Healthcare Provider Details

I. General information

NPI: 1497876825
Provider Name (Legal Business Name): SOUTHWEST COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6775 PROSPERI DR
TINLEY PARK IL
60477-4789
US

IV. Provider business mailing address

6775 PROSPERI DR
TINLEY PARK IL
60477-4789
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-1260
  • Fax: 708-429-9107
Mailing address:
  • Phone: 708-429-1260
  • Fax: 708-429-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. MARY PATRICIA AMBROSINO
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N.
Phone: 708-429-1260