Provider Demographics
NPI:1811375843
Name:NORTH RIVER MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:NORTH RIVER MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOKYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-889-2056
Mailing Address - Street 1:5801 NORTH PULASKI ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646
Mailing Address - Country:US
Mailing Address - Phone:312-744-1906
Mailing Address - Fax:312-744-5568
Practice Address - Street 1:5801 NORTH PULASKI ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646
Practice Address - Country:US
Practice Address - Phone:312-744-1906
Practice Address - Fax:312-744-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health