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General NPI Number Information
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NPI Number | 1457883431
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF HEALTH AND HUMAN SERVICES
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 14714 STATE ST
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City | DOLTON
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State | IL
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Zip | 60419-1517
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Country | US
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Telephone | 708-267-3088
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Fax |
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Provider Business Mailing Address
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Address Line | 14714 STATE ST
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City | DOLTON
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State | IL
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Zip | 60419-1517
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Country | US
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Telephone | 708-267-3088
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MRS. PEARL D BALLARD
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Credential |
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Telephone | 708-267-3088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 041296287
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License Number State | IL
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