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General NPI Number Information
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NPI Number | 1669251856
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Entity Type | Organization
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Legal Business Name | ROGERS BEHAVIORAL HEALTH - ILLINOIS INC.
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 907 N ELM ST STE 300
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City | HINSDALE
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State | IL
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Zip | 60521-3645
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Country | US
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Telephone | 630-686-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 34700 VALLEY RD
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4500
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Country | US
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Telephone | 414-326-0104
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | CINDY MEYER
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Credential | MSSW
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Telephone | 262-303-0580
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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