Provider Demographics
NPI:1740019017
Name:NORTHEAST DUPAGE FAMILY AND YOUTH SERVICES
Entity type:Organization
Organization Name:NORTHEAST DUPAGE FAMILY AND YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-903-6220
Mailing Address - Street 1:777 W ARMY TRAIL BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3163
Mailing Address - Country:US
Mailing Address - Phone:630-693-7934
Mailing Address - Fax:
Practice Address - Street 1:777 W ARMY TRAIL BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3163
Practice Address - Country:US
Practice Address - Phone:630-693-7934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health