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Organization
PROVISO FAMILY SERVICES
Active
Organization
PROVISO FAMILY SERVICES
Active
Other names
Resurrection Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTIN KAMISKI (MANAGER, GENERAL ACCOUNTING)
(708) 338-3806
Entity
Organization
Contact information
Practice address
100 N RIVER RD, DES PLAINES, IL 60016-1209
(708) 338-3806
(708) 681-1289
Mailing address
1820 S 25TH AVE, BROADVIEW, IL 60155-2864
(708) 338-3806
(708) 681-1289
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616027
BCBS
IL
Enumeration date
08/11/2008
Last updated
08/11/2008
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