Provider Demographics
NPI:1043345119
Name:DUANE DEAN BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:DUANE DEAN BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORRAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-564-9070
Mailing Address - Street 1:700 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-4131
Mailing Address - Country:US
Mailing Address - Phone:815-939-0125
Mailing Address - Fax:815-939-1249
Practice Address - Street 1:700 E COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-4131
Practice Address - Country:US
Practice Address - Phone:815-939-0125
Practice Address - Fax:815-939-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
IL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid