Provider Demographics
NPI:1083141493
Name:PRESENCE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:PRESENCE BEHAVIORAL HEALTH
Other - Org Name:ST. MARY & ST. ELIZABETH MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PERHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-770-2317
Mailing Address - Street 1:1127 N OAKLEY BLVD
Mailing Address - Street 2:NFC BLDG 3RD FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3507
Mailing Address - Country:US
Mailing Address - Phone:312-770-2317
Mailing Address - Fax:312-770-2557
Practice Address - Street 1:1127 N OAKLEY BLVD
Practice Address - Street 2:NFC BLDG 3RD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3507
Practice Address - Country:US
Practice Address - Phone:312-770-2317
Practice Address - Fax:312-770-2557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESENCE CHICAGO HOPSITAL NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health