Provider Demographics
NPI:1558539718
Name:FAMILY SERVICE ASSOCIATION OF GREATER ELGIN AREA
Entity Type:Organization
Organization Name:FAMILY SERVICE ASSOCIATION OF GREATER ELGIN AREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-695-3680
Mailing Address - Street 1:1535 BURGUNDY PKWY
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1811
Mailing Address - Country:US
Mailing Address - Phone:847-695-3680
Mailing Address - Fax:
Practice Address - Street 1:1535 BURGUNDY PKWY
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1811
Practice Address - Country:US
Practice Address - Phone:847-695-3680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid