Provider Demographics
NPI:1003181678
Name:MENTAL HEALTH AND DEAFNESS RESOURCES, INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH AND DEAFNESS RESOURCES, INC.
Other - Org Name:PRAIRIEVIEW 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-509-8260
Mailing Address - Street 1:614 ANTHONY TRL
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2540
Mailing Address - Country:US
Mailing Address - Phone:847-509-8260
Mailing Address - Fax:
Practice Address - Street 1:3024 E OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6214
Practice Address - Country:US
Practice Address - Phone:309-661-1605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities