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General NPI Number Information
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NPI Number | 1851782817
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Entity Type | Organization
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Legal Business Name | QUALITY BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 3400 S INDIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3841
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Country | US
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Telephone | 773-684-4282
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Fax |
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Provider Business Mailing Address
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Address Line | 12420 S LAFLIN ST
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City | CALUMET PARK
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State | IL
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Zip | 60827-5713
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Country | US
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Telephone | 773-484-6796
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MYRIAM TILLMAN
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Credential |
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Telephone | 773-484-6796
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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 | 149004649
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License Number State | IL
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