Provider Demographics
NPI:1780016949
Name:THE JOSSELYN CENTER NFP
Entity Type:Organization
Organization Name:THE JOSSELYN CENTER NFP
Other - Org Name:THE JOSSELYN CENTER - DEERFIELD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHULER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-441-5600
Mailing Address - Street 1:405 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3006
Mailing Address - Country:US
Mailing Address - Phone:847-441-5600
Mailing Address - Fax:847-441-7968
Practice Address - Street 1:130 N WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5218
Practice Address - Country:US
Practice Address - Phone:847-940-8400
Practice Address - Fax:847-441-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054322Medicaid
IL036054322Medicaid
IL909630Medicare PIN