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General NPI Number Information
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NPI Number | 1164715181
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Entity Type | Organization
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Legal Business Name | BEVERLY GROUP MENTAL HEALTH SERVICES, INC
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 4444 S BERKELEY AVE
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City | CHICAGO
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State | IL
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Zip | 60653-3610
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Country | US
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Telephone | 773-490-0576
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Fax | 773-303-8345
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Provider Business Mailing Address
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Address Line | PO BOX 4811
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City | CHICAGO
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State | IL
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Zip | 60680-4811
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Country | US
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Telephone | 773-490-0576
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Fax | 773-303-8345
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY RIGGIO
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Credential | LCSW,MSW,MS,CADC
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Telephone | 773-490-0576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149010964
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License Number State | IL
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