Provider Demographics
NPI:1386028835
Name:THE DUBOIS DOUGLAS CENTRES
Entity Type:Organization
Organization Name:THE DUBOIS DOUGLAS CENTRES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINS-MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-283-0886
Mailing Address - Street 1:4747 LINCOLN MALL DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3811
Mailing Address - Country:US
Mailing Address - Phone:708-283-0886
Mailing Address - Fax:708-283-0895
Practice Address - Street 1:4747 LINCOLN MALL DR
Practice Address - Street 2:SUITE 301
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3811
Practice Address - Country:US
Practice Address - Phone:708-283-0886
Practice Address - Fax:708-283-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL199500004C320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities