Organization
RESURRECTION HEALTH CARE
Active
Other names
Resurrection Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN MYRON NETHERLY MSW, MA, MS (BEHAVIORAL HEALTH TECHNICAM)
(773) 567-5110
Entity
Organization
Contact information
Practice address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
(708) 881-0073
Mailing address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
261QM0801X
IL
Other
Enumeration date
02/02/2012
Last updated
02/02/2012
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