Provider Demographics
NPI:1396795522
Name:FAMILY SERVICE AND COMMUNITY MENTAL HEALTH CENTER FOR MCHENRY COUNTY
Entity type:Organization
Organization Name:FAMILY SERVICE AND COMMUNITY MENTAL HEALTH CENTER FOR MCHENRY COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-385-6400
Mailing Address - Street 1:4100 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4029
Mailing Address - Country:US
Mailing Address - Phone:815-385-6400
Mailing Address - Fax:815-385-8127
Practice Address - Street 1:4100 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4029
Practice Address - Country:US
Practice Address - Phone:815-385-6400
Practice Address - Fax:815-385-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5615096OtherBLUE CROSS
IL5615096OtherBLUE SHIELD
IL5615096OtherBLUE SHIELD