Organization
NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS, INC.
Active
Other names
North Central Stretor DMH Medicaid
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY BLOCK CPA (CFO)
(815) 224-5001
Entity
Organization
Contact information
Practice address
111 SPRING ST STE 320-328, STREATOR, IL 61364-3332
(815) 223-0160
Mailing address
PO BOX 1488, LA SALLE, IL 61301-3488
(815) 223-0160
(815) 223-1634
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
04107
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04107
—
IL
Enumeration date
07/29/2017
Last updated
03/13/2020
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