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General NPI Number Information
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NPI Number | 1942573829
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Entity Type | Organization
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Legal Business Name | THE CENTRE, LLC
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 2026 SAMANTHA JOY LN
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5626
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Country | US
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Telephone | 231-330-6446
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Fax |
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Provider Business Mailing Address
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Address Line | 2026 SAMANTHA JOY LN
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5626
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Country | US
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Telephone | 231-330-6446
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BERNADETTE HELEN BEYER
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Credential | M.A.
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Telephone | 231-330-6446
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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 | 4101005193
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License Number State | MI
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