The Otherside a Behavioral Healthcare Corp

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

THE OTHERSIDE A BEHAVIORAL HEALTHCARE CORP

Doing business as

The Otherside

Practice address

1717 Philo Rd
Suite 23
Urbana, IL 61802-6044

Phone

(217) 607-0098

Fax

(217) 298-0142

NPI assigned

Jun 19, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Leonard Eugene Deforge

Title

Owner/Manager

Phone

(217) 607-0098

Specialties & licenses 1

Addresses

Other names 1

• The Otherside Doing business as

Locations

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1740543305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 PHILO RD",
            "address_2": "SUITE 23",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618026044",
            "telephone_number": "217-607-0098",
            "fax_number": "217-298-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 PHILO RD",
            "address_2": "SUITE 23",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618026044",
            "telephone_number": "217-607-0098",
            "fax_number": "217-298-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OTHERSIDE A BEHAVIORAL HEALTHCARE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-19",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "DEFORGE",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "217-607-0098",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Otherside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Urbana, IL
• Providers in Urbana, 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 Jun 20, 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.