Provider Demographics
NPI:1982143368
Name:ILLINOIS MEDICAL AND BEHAVIORAL CARE, LLC
Entity Type:Organization
Organization Name:ILLINOIS MEDICAL AND BEHAVIORAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIZWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-261-9220
Mailing Address - Street 1:1601 N BOND STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0115
Mailing Address - Country:US
Mailing Address - Phone:630-261-9220
Mailing Address - Fax:630-689-1786
Practice Address - Street 1:1601 N BOND STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-0115
Practice Address - Country:US
Practice Address - Phone:630-261-9220
Practice Address - Fax:630-689-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health