Provider Demographics
NPI:1255730875
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:LICENSED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARWIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-786-8510
Mailing Address - Street 1:2456 N HAMLIN AVE APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2230
Mailing Address - Country:US
Mailing Address - Phone:773-610-5783
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:708-681-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health