PROVISO FAMILY SERVICES NPI 1134376403

NPI Information

  • NPI: 1134376403
  • Provider Name: PROVISO FAMILY SERVICES
  • Classification: Clinic/Center - 261QM0801X
  • Specialization: Mental Health (Including Community Mental Health Center)
  • Entity Type: Organization
  • Doing Business As: RESURRECTION BEHAVIORAL HEALTH
  • Address: 1225 W LAKE ST
    MELROSE PARK, IL
    ZIP 60160
  • Phone: (708) 681-2324

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NPI Details

PROVISO FAMILY SERVICES is a mental health (including community mental health center) clinic center in Melrose Park, IL. PROVISO FAMILY SERVICES NPI is 1134376403. The provider is registered as an organization entity type.
The provider Is Doing Business As Resurrection Behavioral Health.

The provider's business location address is:

1225 W LAKE ST
MELROSE PARK, IL
ZIP 60160-039
Phone: (708) 681-2324
Fax: (708) 345-5496

The provider's authorized official is Kristin Kamiski .
The authorized official title is Manager, General Accounting and has the following contact phone number (708) 338-3806.

The enumeration date for this NPI number is 8/19/2008 and was last updated on 8/19/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11616087OTHERILLINOISBCBS
2619910MEDICARE PINILLINOIS
3619911MEDICARE PINILLINOIS
4204281MEDICARE PINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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