Provider Demographics
NPI:1568430205
Name:METHODIST YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:METHODIST YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JURISHICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-733-8810
Mailing Address - Street 1:954 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2224
Mailing Address - Country:US
Mailing Address - Phone:312-733-8810
Mailing Address - Fax:312-733-8903
Practice Address - Street 1:954 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2224
Practice Address - Country:US
Practice Address - Phone:312-733-8810
Practice Address - Fax:312-733-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL206725-05251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========005Medicaid