=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104720960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2026
-----------------------------------------------------
Last Update Date | 10/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N BURR BLVD
-----------------------------------------------------
City | KEWANEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61443-2214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-391-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2960 CHARTRES ST
-----------------------------------------------------
City | LA SALLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61301-1031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR, REVENUE CYCLE
-----------------------------------------------------
Name | BEATRIZ RAMIREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-387-5623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------