Provider Demographics
NPI:1396919460
Name:FIRST LIFE BEHAVIORAL HEALTH LTD.
Entity type:Organization
Organization Name:FIRST LIFE BEHAVIORAL HEALTH LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-210-9085
Mailing Address - Street 1:465 W 162ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2010
Mailing Address - Country:US
Mailing Address - Phone:708-210-9085
Mailing Address - Fax:708-210-9386
Practice Address - Street 1:465 W 162ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2010
Practice Address - Country:US
Practice Address - Phone:708-210-9085
Practice Address - Fax:708-210-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health