Provider Demographics
NPI:1902192305
Name:MENTAL HEALTH AND DEAFNESS RESOURCES
Entity Type:Organization
Organization Name:MENTAL HEALTH AND DEAFNESS RESOURCES
Other - Org Name:PRAIRIEVIEW CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-509-8260
Mailing Address - Street 1:614 ANTHONY TRL
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2540
Mailing Address - Country:US
Mailing Address - Phone:847-509-8260
Mailing Address - Fax:847-509-8157
Practice Address - Street 1:19407 US HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61705-5858
Practice Address - Country:US
Practice Address - Phone:309-378-1509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL398621320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness