NPIMap

Organization Active NPI

Proviso Family Services

Doing business as Resurrection Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Des Plaines, IL
National Provider Identifier
1588810550
Registry record updated Aug 11, 2008
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
PROVISO FAMILY SERVICES
Doing business as
Resurrection Behavioral Health
Practice address
100 N River Rd
Des Plaines, IL 60016-1209
Phone
(708) 338-3806
Fax
(708) 681-1289
NPI assigned
Aug 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2008

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

Authorized official

Name
Mrs. Kristin Kamiski
Title
Manager, General Accounting
Phone
(708) 338-3806

Specialties & licenses 1

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

Addresses

Primary practice location

100 N River Rd
Des Plaines, IL 60016-1209

Mailing address

1820 S 25TH Ave
Broadview, IL 60155-2864
Phone (708) 338-3806

Other identifiers 1

IdentifierTypeStateIssuer
1616027OtherILBCBS

Other names 1

  • Resurrection Behavioral Health Doing business as

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": "1218412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1588810550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 S 25TH AVE",
            "city": "BROADVIEW",
            "state": "IL",
            "postal_code": "601552864",
            "telephone_number": "708-338-3806",
            "fax_number": "708-681-1289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N RIVER RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161209",
            "telephone_number": "708-338-3806",
            "fax_number": "708-681-1289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISO FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-11",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "KAMISKI",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "MANAGER, GENERAL ACCOUNTING",
        "authorized_official_telephone_number": "708-338-3806",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1616027",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Resurrection Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Des Plaines, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; 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.