ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH

Provider Demographics

• NPI: 1689674038
• Name: ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
• Entity Type: Organization
• Organization Name: ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
• Authorized Official - Title/Position: EXECUTIVE DIRECTOR
• Authorized Official - First Name: RICK
• Authorized Official - Last Name: GERMANN
• Authorized Official - Phone: 847-952-7460
• Mailing Address - Street 1: PO BOX 26852
• Mailing Address - City: BELFAST
• Mailing Address - State: ME
• Mailing Address - Zip Code: 04915-2019
• Mailing Address - Country: US
• Mailing Address - Phone: 847-952-7460
• Mailing Address - Fax: 847-222-1754
• Practice Address - Street 1: 3436 N. KENNICOTT AVENUE
• Practice Address - City: ARLINGTON HEIGHTS
• Practice Address - State: IL
• Practice Address - Zip Code: 60004-7814
• Practice Address - Country: US
• Practice Address - Phone: 847-952-7460
• Practice Address - Fax: 847-222-1754
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-07-28
• Last Update Date: 2022-07-25

Provider Licenses

State	License ID	Taxonomies
IL	04005	1041C0700X
		251S00000X, 261QM0801X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Single Specialty
No	251S00000X	Agencies	Community/Behavioral Health

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IL	1617886	Other	BLUE SHIELD
IL	3630045007010	Medicaid
IL	=========012	Medicaid
IL	=========006	Medicaid
IL	=========007	Medicaid
IL	=========009	Medicaid
IL	=========013	Medicaid
IL	=========005	Medicaid
IL	=========014	Medicaid
IL	=========008	Medicaid
IL	=========011	Medicaid
IL	=========015	Medicaid
IL	3630045007010	Medicaid
IL	=========009	Medicaid