| Full Name | |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 1680 Mark Ave, Elgin, Illinois |
| Authorized Official Name and Position | Pauline Rochfort (BILLING DIRECTOR) |
| Authorized Official Contact | 8476950484 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1845 Grandstand Pl Elgin IL 60123-6603 Ph: (847) 695-0484 | 1680 Mark Ave Elgin IL 60123-2907 Ph: (847) 695-0484 |
| NPI Number | 1114312097 |
|---|---|
| Provider Enumeration Date | 03/30/2015 |
| Last Update Date | 07/20/2020 |
| Certification Date | 07/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114312097 | NPI | - | NPPES |
| 04050 | Medicaid | IL |
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