Provider Demographics
NPI:1073925772
Name:KENNETH YOUNG CENTER
Entity Type:Organization
Organization Name:KENNETH YOUNG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-524-8800
Mailing Address - Street 1:335 SCHREIBER AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1064
Mailing Address - Country:US
Mailing Address - Phone:224-200-7378
Mailing Address - Fax:
Practice Address - Street 1:1001 ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3217
Practice Address - Country:US
Practice Address - Phone:847-524-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010050251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health