| Kankakee West House | |
|
800 W Harbor St Kankakee IL 60901-2945 | |
| (773) 572-5500 | |
| Not Available |
| Full Name | Kankakee West House |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 800 W Harbor St, Kankakee, Illinois |
| Authorized Official Name and Position | Marcella Klauer (EXECUTIVE ASSISTANT) |
| Authorized Official Contact | 7735725480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kankakee West House 4101 N Ravenswood Ave Chicago IL 60613-2193 Ph: (773) 572-5500 | Kankakee West House 800 W Harbor St Kankakee IL 60901-2945 Ph: (773) 572-5500 |
| NPI Number | 1518114040 |
|---|---|
| Provider Enumeration Date | 08/27/2008 |
| Last Update Date | 07/14/2022 |
| Certification Date | 07/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518114040 | NPI | - | NPPES |
| 04133 | Medicaid | IL |
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