Organization
PROVISO FAMILY SERVICES
Active
Other names
Resurrection Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTIN KAMINSKI (MANAGER, GENERAL ACCOUNTING)
(708) 338-3806
Entity
Organization
Contact information
Practice address
3 ERIE CT, OAK PARK, IL 60302-2519
(708) 681-2324
(708) 345-5496
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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