Organization
PROVISO PUBLIC PARTNERSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATE MINELLA (CHIEF FINANCIAL OFFICER)
(708) 240-4435
Entity
Organization
Contact information
Practice address
4565 HARRISON ST FL 3, HILLSIDE, IL 60162-1617
(708) 240-4435
(708) 449-6421
Mailing address
4565 HARRISON ST FL 3, HILLSIDE, IL 60162-1617
(708) 240-4435
(708) 449-6421
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/22/2018
Last updated
07/22/2021
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