Organization
HB COMMUNITY IDENTITY CARE SERVICES
Active
Other names
CIC Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNATHAN MATTHEW JOHNSON SR. PHD. (CEO/ PRESIDENT)
(708) 439-1832
Entity
Organization
Contact information
Practice address
15301 S. LEXINGTON AVE., HARVEY, IL 60426
(708) 439-1832
Mailing address
15301 S. LEXINGTON AVE., HARVEY, IL 60426
(708) 439-1832
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
—
—
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
282J00000X
Religious Nonmedical Health Care Institution
—
—
Other
Enumeration date
05/23/2023
Last updated
08/04/2024
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