MEDICARE: HOPE BEHAVIORAL SERVICES AT THE JEANNINE BRENT CENTER INCORPORATED

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1457829632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE BEHAVIORAL SERVICES AT THE JEANNINE BRENT CENTER INCORPORATED

Provider Business Mailing Address
First Line	:	2319 PLAINFIELD RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-1875
Country	:	US
Telephone Number	:	815-260-7203
Fax Number	:	844-270-2128

Provider Business Practice Location Address
First Line	:	2319 PLAINFIELD RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-1875
Country	:	US
Telephone Number	:	815-260-7203
Fax Number	:	844-270-2128

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BETH MARIE HAWKINS
Credential	:	LCSW, CAADC
Telephone Number	:	815-260-7203

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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