Provider Demographics
NPI:1093582306
Name:GRIEF RIVER, LLC
Entity Type:Organization
Organization Name:GRIEF RIVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:D MIN
Authorized Official - Phone:773-454-9176
Mailing Address - Street 1:1 CAYUGA TRL
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-9430
Mailing Address - Country:US
Mailing Address - Phone:773-454-9176
Mailing Address - Fax:815-930-0005
Practice Address - Street 1:800 SPRING ST STE 101
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-2003
Practice Address - Country:US
Practice Address - Phone:773-454-9176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty