Provider Demographics
NPI:1639221302
Name:ILLINOIS DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:ILLINOIS DEPARTMENT OF HUMAN SERVICES
Other - Org Name:ELGIN MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MA
Authorized Official - Phone:847-742-1040
Mailing Address - Street 1:750 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7612
Mailing Address - Country:US
Mailing Address - Phone:847-742-1040
Mailing Address - Fax:847-429-4910
Practice Address - Street 1:750 S STATE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7612
Practice Address - Country:US
Practice Address - Phone:847-742-1040
Practice Address - Fax:847-429-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL144037Medicare ID - Type UnspecifiedADMINASTAR FEDERAL