Organization
THE OTHERSIDE A BEHAVIORAL HEALTHCARE CORP
Active
Other names
The Otherside
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD EUGENE DEFORGE (OWNER/MANAGER)
(217) 607-0098
Entity
Organization
Contact information
Practice address
1717 PHILO RD, SUITE 23, URBANA, IL 61802-6044
(217) 607-0098
(217) 298-0142
Mailing address
1717 PHILO RD, SUITE 23, URBANA, IL 61802-6044
(217) 607-0098
(217) 298-0142
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/19/2012
Last updated
06/20/2012
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