Provider Demographics
NPI:1407984131
Name:PREVENTATIVE MENTAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:PREVENTATIVE MENTAL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANGELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-968-1181
Mailing Address - Street 1:1001 OGDEN AVE
Mailing Address - Street 2:LL5
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2865
Mailing Address - Country:US
Mailing Address - Phone:630-968-1181
Mailing Address - Fax:630-322-9977
Practice Address - Street 1:1001 OGDEN AVE
Practice Address - Street 2:LL5
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2865
Practice Address - Country:US
Practice Address - Phone:630-968-1181
Practice Address - Fax:630-322-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL620100Medicare ID - Type UnspecifiedMEDICARE