Provider Demographics
NPI:1598840936
Name:FAMILY CHILD & ADOLESCENT PSYCHIATRIC SERVICES SC
Entity Type:Organization
Organization Name:FAMILY CHILD & ADOLESCENT PSYCHIATRIC SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SERVICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILA
Authorized Official - Middle Name:B
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-282-0060
Mailing Address - Street 1:833 W 15TH PL
Mailing Address - Street 2:UNIT 815
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1429
Mailing Address - Country:US
Mailing Address - Phone:708-206-1300
Mailing Address - Fax:708-206-1399
Practice Address - Street 1:1 OLD FRANKFORT WAY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1719
Practice Address - Country:US
Practice Address - Phone:708-206-1300
Practice Address - Fax:708-206-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360674682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL119475OtherCOMPSYCH PROVIDER #
IL036067468OtherLICENSE #
IL155000OtherPSYCHEALTH PROVIDER #
IL166548OtherHARMONY PROVIDER #
IL018896OtherVALUEOPTIONS PROVIDER #
IL036067468Medicaid
IL3103879OtherBCBS
IL31603879OtherBCBS PROVIDER #
IL35928OtherAMERICAID PROVIDER #
IL119475OtherCOMPSYCH PROVIDER #