Provider Demographics
NPI:1508965724
Name:MENTAL HEALTH SERVICE LINE
Entity Type:Organization
Organization Name:MENTAL HEALTH SERVICE LINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB TECH
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CADC
Authorized Official - Phone:708-202-8387
Mailing Address - Street 1:429 SHERIDAN RD
Mailing Address - Street 2:APARTMENT 16
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1336
Mailing Address - Country:US
Mailing Address - Phone:847-681-0706
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE AND ROOSEVELT ROAD
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit