| Garden Of Prayer Youth Center Incorporated | |
|
16601 E State Route 114 Momence IL 60954-3812 | |
| (815) 933-2493 | |
| Not Available |
| Full Name | Garden Of Prayer Youth Center Incorporated |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 16601 E State Route 114, Momence, Illinois |
| Authorized Official Name and Position | Michael Maloney (CEO, EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8159332493 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Garden Of Prayer Youth Center Incorporated 657 E Court St Ste 200 Kankakee IL 60901-4071 Ph: (815) 933-2493 | Garden Of Prayer Youth Center Incorporated 16601 E State Route 114 Momence IL 60954-3812 Ph: (815) 933-2493 |
| NPI Number | 1023611647 |
|---|---|
| Provider Enumeration Date | 11/17/2020 |
| Last Update Date | 01/08/2021 |
| Certification Date | 01/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023611647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Garden Of Prayer Youth Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 16424 East State Route 114, Momence, IL 60954 Phone: 815-472-2490 |