Provider Demographics
NPI:1467022913
Name:CLEARBROOK CMHC COOK
Entity Type:Organization
Organization Name:CLEARBROOK CMHC COOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GORRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-385-5041
Mailing Address - Street 1:1835 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2410
Mailing Address - Country:US
Mailing Address - Phone:847-385-5041
Mailing Address - Fax:
Practice Address - Street 1:1895 ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4802
Practice Address - Country:US
Practice Address - Phone:478-385-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARBROOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)