Provider Demographics
NPI:1649774225
Name:IROQUOIS MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:IROQUOIS MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC. EXEC DIR OF HR AND FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-432-5241
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-0322
Mailing Address - Country:US
Mailing Address - Phone:815-432-5241
Mailing Address - Fax:
Practice Address - Street 1:1137 E 5000N RD STE K
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4229
Practice Address - Country:US
Practice Address - Phone:815-432-5241
Practice Address - Fax:815-432-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health