Basic Information
| Provider Information | |||||||||
| NPI: | 1447520739 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RESURRECTION HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601603902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086810073 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1414 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601603902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086810073 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2012 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | KINH-HOOKS | ||||||||
| AuthorizedOfficialFirstName: | JOYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BEHAVIORAL HEALTH TECHNICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3124527653 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.