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7200 Clinton Rd Loves Park IL 61111-3806 | |
| (815) 962-8333 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 7200 Clinton Rd, Loves Park, Illinois |
| Authorized Official Name and Position | William Nelson (CEO) |
| Authorized Official Contact | 3093442323 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7200 Clinton Rd Loves Park IL 61111-3806 Ph: (815) 962-8333 | 7200 Clinton Rd Loves Park IL 61111-3806 Ph: (815) 962-8333 |
| NPI Number | 1235626326 |
|---|---|
| Provider Enumeration Date | 04/16/2018 |
| Last Update Date | 04/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235626326 | NPI | - | NPPES |
| 655360 | Other | IL | UPIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Illinois) | Primary |
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