Provider Demographics
NPI:1649423930
Name:FAMILY SERVICE & COMMUNITY MENTAL HEALTH CENTER FOR MCHENRY COUNTY
Entity Type:Organization
Organization Name:FAMILY SERVICE & COMMUNITY MENTAL HEALTH CENTER FOR MCHENRY COUNTY
Other - Org Name:FAMILY SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-385-6400
Mailing Address - Street 1:4100 VETERANS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:815-385-6400
Mailing Address - Fax:
Practice Address - Street 1:4100 VETERANS PARKWAY
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-385-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL197.000046251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========005Medicaid