Sertoma Centre, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SERTOMA CENTRE, INC.

Practice address

4343 W 123Rd St
Alsip, IL 60803-1807

Phone

(708) 739-6216

Fax

(708) 371-9700

NPI assigned

Oct 7, 2020

Organization subpart

No

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

Authorized official

Name

Gus Van Den Brink, LCSW

Title

Executive Director

Phone

(708) 730-6216

Specialties & licenses 1

Addresses

Tax ID family

Sertoma Centre Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Sertoma Centre, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alsip, IL
  • NPI 1194348359
  NPD tax ID
• Sertoma Centre, Inc.

  • Voluntary or Charitable Agency
  • Alsip, IL
  • NPI 1235241720
  NPD tax ID
• Sertoma Centre, Inc.

  • Voluntary or Charitable Agency
  • Alsip, IL
  • NPI 1306170592
  NPD tax ID
• Sertoma Centre, Inc.

  • Case Management Agency
  • Matteson, IL
  • NPI 1417431537
  NPD tax ID

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

{
    "created_epoch": "1602028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602028800000",
    "number": "1982201414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 W 123RD ST",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608031807",
            "telephone_number": "708-739-6216",
            "fax_number": "708-371-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 W 123RD ST",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608031807",
            "telephone_number": "708-739-6216",
            "fax_number": "708-371-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERTOMA CENTRE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-07",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "VAN DEN BRINK",
        "authorized_official_first_name": "GUS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-730-6216",
        "authorized_official_credential": "LCSW"
    },
    "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": []
}

• Allison Schering, M.A., CCC-SLP
• Theresa Seemann, MS, CCC-SLP
• Sertoma Centre, Inc.
• Sertoma Centre, Inc.
• Sertoma Centre, Inc.
• Sertoma Star Services, Inc.
• Sertoma Star Services, Inc.
• Naim Shuaipaj, DMD
• John R Sintich
• Hayley Skabelund, PA-C

• Mental Health Clinic/Center (Including Community Mental Health Center) in Alsip, IL
• Providers in Alsip, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; 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.