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NPI Code Detail

MEDICARE: JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER

MEDICARE: JANE ADDAMS COMMUNITY 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1548744782
Entity Type Code : Organization
Provider Name (Legal Business Name) : JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER
Provider Business Mailing Address
First Line : PO BOX 813
Second Line :
City : FREEPORT
State : IL
Zip : 61032-0813
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2107 CHICAGO AVE
Second Line :
City : SAVANNA
State : IL
Zip : 61074-1716
Country : US
Telephone Number : 815-273-3323
Fax Number :
Authorized Official
Title or Position : VP OF PATIENT SERVICES
Name : KATHRYN MARTINEZ
Credential :
Telephone Number : 815-599-7529
Provider Enumeration Date : 09/24/2018
Last Update Date : 09/24/2018

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Directions to “JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER ” Practice Location

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