1528294451 NPI number — FAMILIES MATTER BEHAVIORAL HEALTH, INC.

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 1528294451 NPI number — FAMILIES MATTER BEHAVIORAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILIES MATTER BEHAVIORAL HEALTH, INC.
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:
1528294451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 MID AMERICA PLZ
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
OAKBROOK TERRACE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-4451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-932-7679
Provider Business Mailing Address Fax Number:
630-691-0901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 MID AMERICA PLZ
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
OAKBROOK TERRACE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60181-4451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-932-7679
Provider Business Practice Location Address Fax Number:
630-691-0901
Provider Enumeration Date:
06/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
DEA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
CLINICAL DIRECTOR/PRACTITIONER
Authorized Official Telephone Number:
630-932-7679

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  18153 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 149010064 , 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)

  • Identifier: 2207910 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 237950 . This is a "LIFESYNC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 720545000 . This is a "MAELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12037244 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784852 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 508694 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 439589 . This is a "MHN" identifier . This identifiers is of the category "OTHER".




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