Provider Demographics
NPI:1013240423
Name:SERTOMA CENTRE, INC.
Entity Type:Organization
Organization Name:SERTOMA CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DEN BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-371-9700
Mailing Address - Street 1:4343 W 123RD ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-1807
Mailing Address - Country:US
Mailing Address - Phone:708-371-9700
Mailing Address - Fax:708-371-9747
Practice Address - Street 1:4331 LINCOLN HWY
Practice Address - Street 2:SUITE A
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2404
Practice Address - Country:US
Practice Address - Phone:708-748-1951
Practice Address - Fax:708-748-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========OtherIDHS