Provider Demographics
NPI:1104230077
Name:GENUINE HEARTS BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:GENUINE HEARTS BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-207-5028
Mailing Address - Street 1:400 W 76TH ST
Mailing Address - Street 2:UNIT 216A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-1640
Mailing Address - Country:US
Mailing Address - Phone:872-207-5028
Mailing Address - Fax:
Practice Address - Street 1:400 W 76TH ST
Practice Address - Street 2:UNIT 216A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-1640
Practice Address - Country:US
Practice Address - Phone:872-207-5028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04826191251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health