| Garden Of Prayer Youth Center | |
|
16424 East State Route 114 Momence IL 60954 | |
| (815) 472-2490 | |
| Not Available |
| Full Name | Garden Of Prayer Youth Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 16424 East State Route 114, Momence, Illinois |
| Authorized Official Name and Position | Michael Maloney (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 657 E Court St Kankakee IL 60901-4055 Ph: (815) 933-2493 | Garden Of Prayer Youth Center 16424 East State Route 114 Momence IL 60954 Ph: (815) 472-2490 |
| NPI Number | 1427302413 |
|---|---|
| Provider Enumeration Date | 10/30/2012 |
| Last Update Date | 10/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427302413 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 041-129-294 (Illinois) | Primary |
Garden Of Prayer Youth Center Incorporated Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 16601 E State Route 114, Momence, IL 60954 Phone: 815-933-2493 |