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117 S 6th Ave Maywood IL 60153-1377 | |
| (708) 681-2324 | |
| (708) 345-5496 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 117 S 6th Ave, Maywood, Illinois |
| Authorized Official Name and Position | Kristin Kaminski (MANAGER, GENERAL ACCOUNTING) |
| Authorized Official Contact | 7083383806 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1820 S 25th Ave Broadview IL 60155-2864 Ph: (708) 338-3806 | 117 S 6th Ave Maywood IL 60153-1377 Ph: (708) 681-2324 |
| NPI Number | 1225285596 |
|---|---|
| Provider Enumeration Date | 08/19/2008 |
| Last Update Date | 06/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225285596 | NPI | - | NPPES |
| 1616027 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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