Healthcare Provider Details

I. General information

NPI: 1679670186
Provider Name (Legal Business Name): ILLINOIS DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 183RD ST
TINLEY PARK IL
60477-3688
US

IV. Provider business mailing address

7400 183RD ST
TINLEY PARK IL
60477-3688
US

V. Phone/Fax

Practice location:
  • Phone: 708-614-4041
  • Fax: 708-614-4496
Mailing address:
  • Phone: 708-614-4041
  • Fax: 708-614-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. CHRISTINE TESMOND
Title or Position: REIMBURSEMENT OFFICER
Credential:
Phone: 708-614-4041