Provider Demographics
NPI:1972849719
Name:ECKER CENTER FOR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ECKER CENTER FOR BEHAVIORAL HEALTH
Other - Org Name:ECKER CENTER FOR MENTAL HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHFORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-695-0484
Mailing Address - Street 1:1845 GRANDSTAND PL
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6603
Mailing Address - Country:US
Mailing Address - Phone:847-695-0484
Mailing Address - Fax:
Practice Address - Street 1:52 SURREY DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5157
Practice Address - Country:US
Practice Address - Phone:224-856-5760
Practice Address - Fax:224-227-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
IL04050320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04050Medicaid