Provider Demographics
NPI:1598047946
Name:CITY OF CHICAGO: NORTH RIVER BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:CITY OF CHICAGO: NORTH RIVER BEHAVIORAL HEALTH CENTER
Other - Org Name:NORTH RIVER BEHAVIORAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:312-744-1906
Mailing Address - Street 1:5801 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6007
Mailing Address - Country:US
Mailing Address - Phone:312-744-1906
Mailing Address - Fax:
Practice Address - Street 1:5801 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6007
Practice Address - Country:US
Practice Address - Phone:312-744-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health