| Western Lake | |
|
21 W Grand Ave Fox Lake IL 60020-1209 | |
| (847) 587-9700 | |
| (847) 587-8584 |
| Full Name | Western Lake |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 21 W Grand Ave, Fox Lake, Illinois |
| Authorized Official Name and Position | Jeff Roy Hedien (DIRECTOR/ SOLE MBR OWNER) |
| Authorized Official Contact | 8475879700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Lake 21 W Grand Ave Fox Lake IL 60020-1209 Ph: (847) 587-9700 | Western Lake 21 W Grand Ave Fox Lake IL 60020-1209 Ph: (847) 587-9700 |
| NPI Number | 1992893010 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 07/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992893010 | NPI | - | NPPES |
| A 1450 0002 A | Other | DEPT OF HUMAN SERVICES OFFICE OF ALCOHOL & SUBSTANCE ABUSE (DHS/DASA) |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A-1450-0002-A (Illinois) | Primary |
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Mathers Recovery Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 101 Towne Centre Ln, Fox Lake, IL 60020 Phone: 815-444-9999 Fax: 815-986-1363 | |
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