Organization
MYSI CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDI BRADLEY (QUALITY IMPROVEMENT MANAGER)
(773) 569-7005
Entity
Organization
Contact information
Practice address
1737 W TOUHY AVE, CHICAGO, IL 60626-2417
(773) 743-8837
(773) 743-8840
Mailing address
3001 W 111TH ST STE 103, CHICAGO, IL 60655-2240
(773) 840-4600
(773) 840-4607
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
05
—
15011
—
IL
Enumeration date
12/21/2020
Last updated
12/21/2020
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