Provider Demographics
NPI:1518087188
Name:MAINE CENTER, INC.
Entity Type:Organization
Organization Name:MAINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR, PROFESSIONAL SE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-696-1570
Mailing Address - Street 1:819 BUSSE HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2360
Mailing Address - Country:US
Mailing Address - Phone:847-696-1570
Mailing Address - Fax:847-696-1587
Practice Address - Street 1:819 BUSSE HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2360
Practice Address - Country:US
Practice Address - Phone:847-696-1570
Practice Address - Fax:847-696-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615408OtherBLUE CROSSBLUE SHIELD
IL604661Medicare ID - Type UnspecifiedMEDICARE CLINICIANS NUMBE
IL1615408OtherBLUE CROSSBLUE SHIELD