NPIMap

Organization Active NPI

Resurrection Health Care

  • Mental Illness Community Based Residential Treatment Facility
  • Melrose Park, IL
National Provider Identifier
1518239706
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
261QM0801X Issued in IL
Legal business name
RESURRECTION HEALTH CARE
Doing business as
Resurrection Behavioral Health
Practice address
1414 Main St
Melrose Park, IL 60160-3902
Phone
(708) 881-0073
NPI assigned
Feb 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Authorized official

Name
Mr. John Myron Netherly, MSW, MA, MS
Title
Behavioral Health Technicam
Phone
(773) 567-5110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 261QM0801X IL Primary

Addresses

Primary practice location

1414 Main St
Melrose Park, IL 60160-3902

Mailing address

1414 Main St
Melrose Park, IL 60160-3902

Other names 1

  • Resurrection Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Resurrection Behavioral Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328140800000",
    "number": "1518239706",
    "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"
        },
        {
            "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": "708-881-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESURRECTION HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-02",
        "last_updated": "2012-02-02",
        "status": "A",
        "authorized_official_last_name": "NETHERLY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MYRON",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH TECHNICAM",
        "authorized_official_telephone_number": "773-567-5110",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, MA, MS"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "IL",
            "license": "261QM0801X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Resurrection Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 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.