NPIMap

Organization Active NPI

Sertoma Centre, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Matteson, IL
National Provider Identifier
1013240423
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SERTOMA CENTRE, INC.
Practice address
4331 Lincoln Hwy
Suite a
Matteson, IL 60443-2404
Phone
(708) 748-1951
Fax
(708) 748-1962
NPI assigned
Sep 16, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gus Van Den Brink, LCSW
Title
Executive Director
Phone
(708) 371-9700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

4331 Lincoln Hwy
Suite a
Matteson, IL 60443-2404

Mailing address

4343 W 123Rd St
Alsip, IL 60803-1807
Phone (708) 371-9700

National Provider Directory

National Provider Directory

Locations

4100 W 127th St
Alsip, IL 60803
Phone (708) 371-9700

4331 Lincoln Hwy
Ste A
Matteson, IL 60443
Phone (708) 748-1951

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613433600000",
    "number": "1013240423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 W 123RD ST",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608031807",
            "telephone_number": "708-371-9700",
            "fax_number": "708-371-9747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4331 LINCOLN HWY",
            "address_2": "SUITE A",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432404",
            "telephone_number": "708-748-1951",
            "fax_number": "708-748-1962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERTOMA CENTRE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-16",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A",
        "authorized_official_last_name": "VAN DEN BRINK",
        "authorized_official_first_name": "GUS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-371-9700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matteson, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.