Provider Demographics
NPI:1740041110
Name:SKYLARK BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SKYLARK BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-629-4696
Mailing Address - Street 1:400 CENTRAL AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3024
Mailing Address - Country:US
Mailing Address - Phone:847-629-4696
Mailing Address - Fax:847-629-4696
Practice Address - Street 1:400 CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3024
Practice Address - Country:US
Practice Address - Phone:847-629-4696
Practice Address - Fax:847-629-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-06-04
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