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General NPI Number Information
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NPI Number | 1740455567
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Entity Type | Organization
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Legal Business Name | JMS BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 2363 N CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60647-2939
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Country | US
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Telephone | 773-786-2514
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 478920
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City | CHICAGO
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State | IL
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Zip | 60647-8920
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Country | US
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Telephone | 773-786-2514
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOSEPHINE DELIRA
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Credential | LCSW
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Telephone | 773-786-2514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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