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4118 Greenleaf Ct Apt 202 Park City IL 60085-7913 | |
| (847) 377-8000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4118 Greenleaf Ct Apt 202, Park City, Illinois |
| Authorized Official Name and Position | Irene T Pierce (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8473778000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3010 Grand Ave Waukegan IL 60085-2321 Ph: (847) 377-8000 | 4118 Greenleaf Ct Apt 202 Park City IL 60085-7913 Ph: (847) 377-8000 |
| NPI Number | 1528370277 |
|---|---|
| Provider Enumeration Date | 07/10/2010 |
| Last Update Date | 07/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528370277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |