Provider Demographics
NPI:1881923910
Name:JOIL CENTER
Entity type:Organization
Organization Name:JOIL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:YAEL
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-653-3059
Mailing Address - Street 1:5140 W MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4224
Mailing Address - Country:US
Mailing Address - Phone:773-653-3059
Mailing Address - Fax:773-526-7512
Practice Address - Street 1:5140 W MELROSE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4224
Practice Address - Country:US
Practice Address - Phone:773-653-3059
Practice Address - Fax:773-526-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-20
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178004814251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003996307Medicaid