Provider Demographics
NPI:1033636675
Name:NOTRE DAME FAMILY CENTERS, INC.
Entity Type:Organization
Organization Name:NOTRE DAME FAMILY CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:WATZKE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, BCPC, LMFT
Authorized Official - Phone:708-671-8199
Mailing Address - Street 1:12919 S 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1818
Mailing Address - Country:US
Mailing Address - Phone:708-671-8199
Mailing Address - Fax:312-277-3544
Practice Address - Street 1:12919 S 86TH AVE
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1818
Practice Address - Country:US
Practice Address - Phone:505-204-8404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)