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General NPI Number Information
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NPI Number | 1194348359
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Entity Type | Organization
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Legal Business Name | SERTOMA CENTRE, INC.
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Dates
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Enumeration Date | 05/22/2020
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 4100 W 127TH ST
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City | ALSIP
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State | IL
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Zip | 60803-1925
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Country | US
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Telephone | 708-371-9700
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Fax | 708-389-3984
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Provider Business Mailing Address
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Address Line | 4343 W 123RD ST
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City | ALSIP
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State | IL
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Zip | 60803-1807
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Country | US
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Telephone | 708-730-6216
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Fax | 708-371-9747
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GUS VAN DEN BRINK
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Credential | MSW, LPHA
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Telephone | 708-730-6216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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