| Ids Group Roselle Inc | |
|
644 E Irving Park Rd Roselle IL 60172-2303 | |
| (847) 668-8969 | |
| (630) 893-8477 |
| Full Name | Ids Group Roselle Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 644 E Irving Park Rd, Roselle, Illinois |
| Authorized Official Name and Position | David C Ideran (PRESIDENT) |
| Authorized Official Contact | 8476688969 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ids Group Roselle Inc 644 E Irving Park Rd Roselle IL 60172-2303 Ph: (847) 668-8969 | Ids Group Roselle Inc 644 E Irving Park Rd Roselle IL 60172-2303 Ph: (847) 668-8969 |
| NPI Number | 1437697455 |
|---|---|
| Provider Enumeration Date | 02/09/2017 |
| Last Update Date | 02/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437697455 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 31870006 (Illinois) | Primary |
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