Provider Demographics
NPI:1699372250
Name:CTF ILLINOIS
Entity Type:Organization
Organization Name:CTF ILLINOIS
Other - Org Name:CTF ILLINOIS -REYNOLDS MH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-429-1260
Mailing Address - Street 1:18230 ORLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5688
Mailing Address - Country:US
Mailing Address - Phone:708-294-1260
Mailing Address - Fax:
Practice Address - Street 1:1400 REYNOLDS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2411
Practice Address - Country:US
Practice Address - Phone:708-429-1260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CTF ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-07
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health