Provider Demographics
NPI:1649329251
Name:MIRACARE NEURO BEHAVIORAL HEALTH, PC
Entity type:Organization
Organization Name:MIRACARE NEURO BEHAVIORAL HEALTH, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:708-448-3300
Mailing Address - Street 1:11800 S 75TH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1033
Mailing Address - Country:US
Mailing Address - Phone:708-448-3300
Mailing Address - Fax:708-448-6972
Practice Address - Street 1:11800 S 75TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1033
Practice Address - Country:US
Practice Address - Phone:708-671-8440
Practice Address - Fax:708-671-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623882OtherBC BS
IL997310OtherMD MEDICARE
IL01623882OtherBC BS