Provider Demographics
NPI:1164612065
Name:CHILDREN'S CENTER FOR BEHAVIORAL DEVELOPEMENT
Entity Type:Organization
Organization Name:CHILDREN'S CENTER FOR BEHAVIORAL DEVELOPEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:AMRHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-398-1152
Mailing Address - Street 1:353 N 88TH ST
Mailing Address - Street 2:HIGHWAY 157 SOUTH
Mailing Address - City:CENTREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62203-2705
Mailing Address - Country:US
Mailing Address - Phone:618-398-1152
Mailing Address - Fax:618-398-6977
Practice Address - Street 1:353 N 88TH ST
Practice Address - Street 2:HIGHWAY 157 SOUTH
Practice Address - City:CENTREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62203-2705
Practice Address - Country:US
Practice Address - Phone:618-398-1152
Practice Address - Fax:618-398-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)