Provider Demographics
NPI:1477618668
Name:ADVANCED BEHAVIORAL CENTERS OF DUPAGE, LLC
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL CENTERS OF DUPAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-986-0599
Mailing Address - Street 1:501 W. OGDEN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-986-0599
Mailing Address - Fax:630-986-1477
Practice Address - Street 1:501 W. OGDEN AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:773-906-4546
Practice Address - Fax:773-304-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2198Medicare UPIN