Provider Demographics
NPI:1902186414
Name:IROQUOIS MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:IROQUOIS MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MA
Authorized Official - Phone:815-432-5241
Mailing Address - Street 1:323 W MULBERRY ST
Mailing Address - Street 2:P.O. BOX 322
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1568
Mailing Address - Country:US
Mailing Address - Phone:815-432-5241
Mailing Address - Fax:815-435-4537
Practice Address - Street 1:107 N. FOURTH STREET
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IL
Practice Address - Zip Code:60966
Practice Address - Country:US
Practice Address - Phone:815-432-5241
Practice Address - Fax:815-432-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04080251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========010Medicaid