Provider Demographics
NPI:1891486742
Name:ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR NET REVENUE AND REIMB
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKNISKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-213-0776
Mailing Address - Street 1:3436 N KENNICOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7814
Mailing Address - Country:US
Mailing Address - Phone:847-952-7460
Mailing Address - Fax:
Practice Address - Street 1:3436 N KENNICOTT AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7814
Practice Address - Country:US
Practice Address - Phone:847-952-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-19
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit