MEDICARE: IROQUOIS MENTAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1326589805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IROQUOIS MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	323 W MULBERRY ST
Second Line	:	PO BOX 322
City	:	WATSEKA
State	:	IL
Zip	:	60970-1568
Country	:	US
Telephone Number	:	815-432-5241
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 N CHESTNUT ST
Second Line	:
City	:	ONARGA
State	:	IL
Zip	:	60955-1255
Country	:	US
Telephone Number	:	815-432-5241
Fax Number	:	815-432-4537

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. DENNIS P. HOPKINS
Credential	:
Telephone Number	:	815-432-5241

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	03/16/2017

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