Provider Demographics
NPI:1023452448
Name:PRESENCE BEHAVIORAL HEALTH PROCARE CENTERS
Entity type:Organization
Organization Name:PRESENCE BEHAVIORAL HEALTH PROCARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW/LSW
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-786-8510
Mailing Address - Street 1:1820 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-2864
Mailing Address - Country:US
Mailing Address - Phone:708-681-0073
Mailing Address - Fax:
Practice Address - Street 1:1414 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3902
Practice Address - Country:US
Practice Address - Phone:708-786-8501
Practice Address - Fax:708-681-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008453251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health