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4118 Greenleaf Ct Park City IL 60085-8509 | |
(847) 377-8170 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 4118 Greenleaf Ct, Park City, Illinois |
Authorized Official Name and Position | Angela Cooper (CFO) |
Authorized Official Contact | 8473778000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3010 Grand Ave. Waukegan IL 60085 Ph: (847) 377-8180 | 4118 Greenleaf Ct Park City IL 60085-8509 Ph: (847) 377-8170 |
NPI Number | 1659583920 |
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Provider Enumeration Date | 05/07/2007 |
Last Update Date | 09/10/2024 |
Certification Date | 09/10/2024 |
Identifier | Type | State | Issuer |
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1659583920 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |