Provider Demographics
NPI:1639466915
Name:BHC STREAMWOOD HOSPITAL INC
Entity Type:Organization
Organization Name:BHC STREAMWOOD HOSPITAL INC
Other - Org Name:JOHN COSTIGAN RESIDENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-483-5578
Mailing Address - Street 1:1360 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-3202
Mailing Address - Country:US
Mailing Address - Phone:630-736-2740
Mailing Address - Fax:630-736-2763
Practice Address - Street 1:1360 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3202
Practice Address - Country:US
Practice Address - Phone:630-736-2740
Practice Address - Fax:630-736-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL346984323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility