Sertoma Star Services, INC.
Clinic/Center, Mental Health (Including Community Mental Health Center) in Alsip, IL. Organization (NPI-2).
NPI number1407618697
StatusActive
Last updated in NPPESFeb 5, 2024
Details
- NPI
- 1407618697
- Entity type
- Organization (NPI-2)
- Legal business name
- Sertoma Star Services, INC.
- Organization subpart
- No
- Enumeration date
- Jan 24, 2024
- Certification date
- Feb 5, 2024
- Last updated
- Feb 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
| 251S00000X | Community/Behavioral Health | – | – | |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | – | – |
Practice location
4343 W 123rd StAlsip, IL 60803-1807
Phone 708-755-8030
Mailing address
1005 W End AveChicago Heights, IL 60411-2742
Authorized official
Gus Van Den Brink
President/Ceo
7087306216
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