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General NPI Number Information
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NPI Number | 1952551756
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Entity Type | Organization
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Legal Business Name | RUSH NEUROBEHAVIORAL CENTER
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 4711 GOLF RD SUITE 1100
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City | SKOKIE
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State | IL
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Zip | 60076-1224
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Country | US
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Telephone | 847-933-9339
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Fax | 847-933-0874
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Provider Business Mailing Address
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Address Line | 4711 GOLF RD SUITE 1100
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City | SKOKIE
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State | IL
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Zip | 60076-1224
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Country | US
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Telephone | 847-933-9339
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Fax | 847-933-0874
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Authorized Official
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Title or Position | PEDIATRIC NEUROLOGIST / EXECUTIVE D
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Name | DR. MERYL E LIPTON
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Credential | M.D., PH.D.
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Telephone | 847-933-9339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 036079515
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License Number State | IL
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