United Mental Health Organization of Illinois

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

UNITED MENTAL HEALTH ORGANIZATION OF ILLINOIS

Practice address

17569 Kedzie Ave
Hazel Crest, IL 60429-2007

Phone

(708) 922-3840

Fax

(708) 922-3850

NPI assigned

Apr 1, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Reuben Frederick Goodwin Sr.

Title

Owner

Phone

(708) 774-5645

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1238544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238544000000",
    "number": "1639311087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3861 MARILYN DR",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604711279",
            "telephone_number": "708-774-5645",
            "fax_number": "708-679-9727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17569 KEDZIE AVE",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292007",
            "telephone_number": "708-922-3840",
            "fax_number": "708-922-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED MENTAL HEALTH ORGANIZATION OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-01",
        "last_updated": "2009-04-01",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "REUBEN",
        "authorized_official_middle_name": "FREDERICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-774-5645",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Hazel Crest, IL
• Providers in Hazel Crest, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; 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.