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General NPI Number Information
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NPI Number | 1518417872
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Entity Type | Organization
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Legal Business Name | LEYDEN FAMILY SERVICE & MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 10001 GRAND AVE
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City | FRANKLIN PARK
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State | IL
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Zip | 60131-2563
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Country | US
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Telephone | 847-451-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 10001 GRAND AVE
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City | FRANKLIN PARK
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State | IL
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Zip | 60131-2563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRUCE SEWICK
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Credential |
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Telephone | 847-451-5077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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