Healthcare Provider Details

I. General information

NPI: 1659260008
Provider Name (Legal Business Name): BCS OF ILLINOIS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WESTBROOK CORPORATE CTR SUITE 300
WESTCHESTER IL
60154-5709
US

IV. Provider business mailing address

39465 W 14 MILE RD
NOVI MI
48377-1600
US

V. Phone/Fax

Practice location:
  • Phone: 877-906-9699
  • Fax:
Mailing address:
  • Phone: 877-906-9699
  • Fax: 888-483-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CLEMENTE
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 877-906-9699