Provider Demographics
NPI:1821114273
Name:ELGHAMMER FAMILY CENTER
Entity Type:Organization
Organization Name:ELGHAMMER FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELGHAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:217-431-6000
Mailing Address - Street 1:723 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4384
Mailing Address - Country:US
Mailing Address - Phone:217-431-6000
Mailing Address - Fax:217-446-0242
Practice Address - Street 1:723 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4384
Practice Address - Country:US
Practice Address - Phone:217-431-6000
Practice Address - Fax:217-446-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty