Provider Demographics
NPI:1497252449
Name:V COVINGTON, LLC
Entity Type:Organization
Organization Name:V COVINGTON, LLC
Other - Org Name:LAKE BEHAVIORAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KRESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-243-5565
Mailing Address - Street 1:2615 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4980
Mailing Address - Country:US
Mailing Address - Phone:855-990-1900
Mailing Address - Fax:847-249-8747
Practice Address - Street 1:2615 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4980
Practice Address - Country:US
Practice Address - Phone:855-990-1900
Practice Address - Fax:847-249-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty