Provider Demographics
NPI:1184260770
Name:CLEARBROOK MCHENRY CMHC
Entity type:Organization
Organization Name:CLEARBROOK MCHENRY CMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HOME BASED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GORRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-385-5041
Mailing Address - Street 1:1835 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2410
Mailing Address - Country:US
Mailing Address - Phone:847-385-5041
Mailing Address - Fax:
Practice Address - Street 1:6500 NORTHWEST HWY UNIT 16E
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3117
Practice Address - Country:US
Practice Address - Phone:815-893-6509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARBROOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-19
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)