Provider Demographics
NPI:1457664146
Name:ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIRGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-952-7460
Mailing Address - Street 1:3350 SALT CREEK LANE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1089
Mailing Address - Country:US
Mailing Address - Phone:847-952-7460
Mailing Address - Fax:847-222-1754
Practice Address - Street 1:332 N. SALEM
Practice Address - Street 2:3G
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1089
Practice Address - Country:US
Practice Address - Phone:847-952-7460
Practice Address - Fax:847-222-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health