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
1	261QM0801X	Mental 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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