Provider Demographics
NPI:1124073143
Name:GLOBAL COMMUNITY MENTAL HEALTH CENTER SE SUB INC
Entity type:Organization
Organization Name:GLOBAL COMMUNITY MENTAL HEALTH CENTER SE SUB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:YAMINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-720-6609
Mailing Address - Street 1:3011 183RD ST
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2804
Mailing Address - Country:US
Mailing Address - Phone:708-720-6609
Mailing Address - Fax:708-748-6180
Practice Address - Street 1:3011 183RD ST
Practice Address - Street 2:SUITE # 300
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2804
Practice Address - Country:US
Practice Address - Phone:708-720-6609
Practice Address - Fax:708-748-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055245207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055245Medicaid
IL036055245Medicaid