Provider Demographics
NPI:1396239802
Name:FAMILY CARE ASSOCIATES OF BOURBONNAIS, INC.
Entity type:Organization
Organization Name:FAMILY CARE ASSOCIATES OF BOURBONNAIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-214-9872
Mailing Address - Street 1:750 ALMAR PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2399
Mailing Address - Country:US
Mailing Address - Phone:815-214-9872
Mailing Address - Fax:
Practice Address - Street 1:750 ALMAR PKWY STE 204
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2399
Practice Address - Country:US
Practice Address - Phone:815-214-9872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty