Provider Demographics
NPI:1720833650
Name:KENNETH YOUNG CENTER
Entity Type:Organization
Organization Name:KENNETH YOUNG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ MERAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-524-8800
Mailing Address - Street 1:1001 ROHLWING RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3217
Mailing Address - Country:US
Mailing Address - Phone:847-524-8800
Mailing Address - Fax:
Practice Address - Street 1:650 E ALGONQUIN RD STE 104
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-3853
Practice Address - Country:US
Practice Address - Phone:847-496-5939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)