Provider Demographics
NPI:1013249143
Name:ROSELAND MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:ROSELAND MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPERTON-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:312-747-9768
Mailing Address - Street 1:200 E 115TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-5015
Mailing Address - Country:US
Mailing Address - Phone:312-747-7320
Mailing Address - Fax:312-747-6250
Practice Address - Street 1:200 E 115TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-5015
Practice Address - Country:US
Practice Address - Phone:312-747-7320
Practice Address - Fax:312-747-6250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICAGO BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149010683251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health