Provider Demographics
NPI:1699220376
Name:LEYDEN FAMILY SERVICE AND MENTAL HEALTH CENTTER
Entity Type:Organization
Organization Name:LEYDEN FAMILY SERVICE AND MENTAL HEALTH CENTTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARZYGNAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-451-5091
Mailing Address - Street 1:10001 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2563
Mailing Address - Country:US
Mailing Address - Phone:847-451-5091
Mailing Address - Fax:847-451-1652
Practice Address - Street 1:10001 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2563
Practice Address - Country:US
Practice Address - Phone:847-451-5091
Practice Address - Fax:847-451-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-0352-0001-AOtherDHS
ILA-0352-0001-AOtherDHS
IL=========005Medicaid