Provider Demographics
NPI:1073831525
Name:BEVERLY GROUP MHS, INC.
Entity Type:Organization
Organization Name:BEVERLY GROUP MHS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOULES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:708-906-7912
Mailing Address - Street 1:4444 S BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3610
Mailing Address - Country:US
Mailing Address - Phone:773-490-0576
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD
Practice Address - Street 2:SUITE 1705
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3606
Practice Address - Country:US
Practice Address - Phone:773-490-0576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0109641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty