NPIMap

Organization Active NPI

Proviso Public Partnership

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hillside, IL
National Provider Identifier
1801304142
Registry record updated Jul 22, 2021
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 PUBLIC PARTNERSHIP
Practice address
4565 Harrison St FL 3
Hillside, IL 60162-1617
Phone
(708) 240-4435
Fax
(708) 449-6421
NPI assigned
Jan 22, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
Kate Minella
Title
Chief Financial Officer
Phone
(708) 240-4435

Specialties & licenses 1

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

Addresses

Primary practice location

4565 Harrison St FL 3
Hillside, IL 60162-1617

Mailing address

4565 Harrison St FL 3
Hillside, IL 60162-1617
Phone (708) 240-4435

Other practice location 1

2619 Congress St
Bellwood, IL 60104-2405
Phone (708) 240-4435

National Provider Directory

National Provider Directory
Tax ID family
Proviso Public Partnership2 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.

Locations

4565 Harrison St
Fl 3
Hillside, IL 60162
Phone (708) 240-4435

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1516579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1801304142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4565 HARRISON ST FL 3",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601621617",
            "telephone_number": "708-240-4435",
            "fax_number": "708-449-6421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4565 HARRISON ST FL 3",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601621617",
            "telephone_number": "708-240-4435",
            "fax_number": "708-449-6421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2619 Congress St",
            "address_purpose": "LOCATION",
            "city": "Bellwood",
            "state": "IL",
            "postal_code": "601042405",
            "country_code": "US",
            "telephone_number": "708-240-4435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVISO PUBLIC PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "MINELLA",
        "authorized_official_first_name": "KATE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "708-240-4435"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillside, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; 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.