Provider Demographics
NPI:1700840402
Name:ALTERNATIVE BEHAVIOR TREATMENT CENTERS
Entity Type:Organization
Organization Name:ALTERNATIVE BEHAVIOR TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:847-487-9455
Mailing Address - Street 1:27255 N FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-9117
Mailing Address - Country:US
Mailing Address - Phone:847-487-9455
Mailing Address - Fax:847-487-9360
Practice Address - Street 1:27255 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-9115
Practice Address - Country:US
Practice Address - Phone:847-487-9455
Practice Address - Fax:847-487-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid