South Haven Behavioral Modification II Inc

Primary specialty

Group Psychotherapy PsychologistTaxonomy code 103TP2701X

Legal business name

SOUTH HAVEN BEHAVIORAL MODIFICATION II INC

Practice address

448-454 E. 61St St
Chicago, IL 60637

Phone

(773) 752-8602

Fax

(773) 752-5824

NPI assigned

Jun 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Dante Pimentel, M.D.NPI 1972591527

Title

President

Phone

(773) 752-8602

Specialties & licenses 1

Addresses

Practitioners 4

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

• Dante Anthony Pimentel, M.D.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1972591527
  NPD (past) Authorized official
• Frank Howard Parker, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Matteson, IL
  • NPI 1457388928
  NPD (past)
• Lori M Riley, MD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1629160965
  NPD (past)
• Ronald E Sam, D.O.

  • Internal Medicine Physician
  • Oak Lawn, IL
  • NPI 1073537643
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386671279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4632 175TH PL",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604784531",
            "telephone_number": "708-785-6597",
            "fax_number": "706-206-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "448-454 E. 61ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60637",
            "telephone_number": "773-752-8602",
            "fax_number": "773-752-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HAVEN BEHAVIORAL MODIFICATION II INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PIMENTEL",
        "authorized_official_first_name": "DANTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-752-8602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Group Psychotherapy Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Group Psychotherapy Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.