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General NPI Number Information
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NPI Number | 1508965724
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH SERVICE LINE
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5TH AVE AND ROOSEVELT ROAD
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City | HINES
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State | IL
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Zip | 60141
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Country | US
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Telephone | 708-202-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 429 SHERIDAN RD APARTMENT 16
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City | HIGHWOOD
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State | IL
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Zip | 60040-1336
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Country | US
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Telephone | 847-681-0706
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Fax |
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Authorized Official
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Title or Position | REHAB TECH
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Name | MR. AARON RICE JR.
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Credential | CADC
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Telephone | 708-202-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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