Provider Demographics
NPI:1679670186
Name:ILLINOIS DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:ILLINOIS DEPARTMENT OF HUMAN SERVICES
Other - Org Name:TINLEY PARK MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-614-4041
Mailing Address - Street 1:7400 183RD ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3688
Mailing Address - Country:US
Mailing Address - Phone:708-614-4041
Mailing Address - Fax:708-614-4496
Practice Address - Street 1:7400 183RD ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3688
Practice Address - Country:US
Practice Address - Phone:708-614-4041
Practice Address - Fax:708-614-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL830500Medicare ID - Type UnspecifiedMEDICARE PART B
IL144019Medicare ID - Type UnspecifiedMEDICARE PROVIDER