| Sertoma Centre, Inc. | |
|
4331 Lincoln Hwy Suite A Matteson IL 60443-2404 | |
| (708) 748-1951 | |
| (708) 748-1962 |
| Full Name | Sertoma Centre, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4331 Lincoln Hwy, Matteson, Illinois |
| Authorized Official Name and Position | Gus Van Den Brink (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7083719700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sertoma Centre, Inc. 4343 W 123rd St Alsip IL 60803-1807 Ph: (708) 371-9700 | Sertoma Centre, Inc. 4331 Lincoln Hwy Suite A Matteson IL 60443-2404 Ph: (708) 748-1951 |
| NPI Number | 1013240423 |
|---|---|
| Provider Enumeration Date | 09/16/2009 |
| Last Update Date | 02/16/2021 |
| Certification Date | 02/16/2021 |
| Medicare PECOS PAC ID | 1557798451 |
|---|---|
| Medicare Enrollment ID | O20200304002624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013240423 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Maria Josephine Mynatt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497877880 PECOS PAC ID: 4688957004 Enrollment ID: I20190104000716 |
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