NPIMap

Organization Active NPI

Resurrection Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Melrose Park, IL
National Provider Identifier
1083978324
Registry record updated Jul 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
178.007422 Issued in IL
Legal business name
RESURRECTION BEHAVIORAL HEALTH
Practice address
1414 Main St
Melrose Park, IL 60160-3902
Phone
(708) 681-0073
Fax
(708) 681-3958
NPI assigned
Jul 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2012

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

Authorized official

Name
Mr. Donald Pinkston, LCSW
Title
Manager
Phone
(708) 681-0073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 178.007422 IL Primary

Addresses

Primary practice location

1414 Main St
Melrose Park, IL 60160-3902

Mailing address

1414 Main St
Melrose Park, IL 60160-3902
Phone (708) 681-0073

Other names 1

  • Proviso Family Services Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Presence Behavioral Health26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1083978324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 MAIN ST",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603902",
            "telephone_number": "708-681-0073",
            "fax_number": "708-681-3958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 MAIN ST",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603902",
            "telephone_number": "708-681-0073",
            "fax_number": "708-681-3958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESURRECTION BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-02",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "PINKSTON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-681-0073",
        "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": "IL",
            "license": "178.007422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proviso Family Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Melrose Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; 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.