Provider Demographics
NPI:1376895532
Name:KENNETH YOUNG CENTER
Entity Type:Organization
Organization Name:KENNETH YOUNG CENTER
Other - Org Name:KENNETH YOUNG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-524-8800
Mailing Address - Street 1:1001 ROHLWING
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60007
Mailing Address - Country:US
Mailing Address - Phone:847-524-8800
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:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service