| Proviso Family Services | |
|
1225 W Lake St Melrose Park IL 60160-4039 | |
| (708) 681-2324 | |
| (708) 345-5496 |
| Full Name | Proviso Family Services |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1225 W Lake St, Melrose Park, Illinois |
| Authorized Official Name and Position | Kristin Kamiski (MANAGER, GENERAL ACCOUNTING) |
| Authorized Official Contact | 7083383806 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proviso Family Services 1820 S 25th Ave Broadview IL 60155-2864 Ph: (708) 338-3806 | Proviso Family Services 1225 W Lake St Melrose Park IL 60160-4039 Ph: (708) 681-2324 |
| NPI Number | 1134376403 |
|---|---|
| Provider Enumeration Date | 08/19/2008 |
| Last Update Date | 08/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134376403 | NPI | - | NPPES |
| 1616087 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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