1013118413 NPI number — BENCHMARK PSYCHIATRIC SERVICES, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013118413 NPI number — BENCHMARK PSYCHIATRIC SERVICES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENCHMARK PSYCHIATRIC SERVICES, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013118413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 379
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462-0379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-460-9833
Provider Business Mailing Address Fax Number:
708-460-1117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11231 DISTINCTIVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60467-9458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-460-9833
Provider Business Practice Location Address Fax Number:
708-460-1117
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAISINGH
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
312-320-7737

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  209004600 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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