Provider Demographics
NPI:1013017839
Name:ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, BUDGET/DECISION SUP
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-590-2555
Mailing Address - Street 1:1650 MOON LAKE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:800-432-5005
Mailing Address - Fax:
Practice Address - Street 1:1650 MOON LAKE BOULEVARD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:800-432-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL402OtherBLUE CROSS BLUE SHIELD
IL402OtherBLUE CROSS BLUE SHIELD
IL144031Medicare ID - Type Unspecified