Provider Demographics
NPI:1992928360
Name:ELMHURST BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:ELMHURST BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF BUSINESS DEVELOPMENT ANC
Authorized Official - Prefix:MS
Authorized Official - First Name:TEDDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KROCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:603-941-4577
Mailing Address - Street 1:183 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2717
Mailing Address - Country:US
Mailing Address - Phone:630-941-4577
Mailing Address - Fax:630-758-5024
Practice Address - Street 1:183 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2717
Practice Address - Country:US
Practice Address - Phone:630-941-4577
Practice Address - Fax:630-758-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5488101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty