| Kankakee River House Cila | |
|
603-605 S Poplar Ave Kankakee IL 60901-5547 | |
| (773) 572-5500 | |
| Not Available |
| Full Name | Kankakee River House Cila |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 603-605 S Poplar Ave, 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 River House Cila 4101 N Ravenswood Ave Chicago IL 60613-2193 Ph: (773) 572-5500 | Kankakee River House Cila 603-605 S Poplar Ave Kankakee IL 60901-5547 Ph: (773) 572-5500 |
| NPI Number | 1548417827 |
|---|---|
| Provider Enumeration Date | 08/19/2008 |
| Last Update Date | 07/14/2022 |
| Certification Date | 07/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548417827 | NPI | - | NPPES |
| 04133 | Medicaid | IL | |
| ========= | Medicaid | IL |
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