Provider Demographics
NPI:1528188380
Name:NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:815-223-0160
Mailing Address - Street 1:17 NORTHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-1159
Mailing Address - Country:US
Mailing Address - Phone:815-223-0160
Mailing Address - Fax:815-223-1634
Practice Address - Street 1:17 NORTHPOINT DR
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-1159
Practice Address - Country:US
Practice Address - Phone:815-223-0160
Practice Address - Fax:815-223-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========012Medicaid