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Contact Information

CENTRAL PROFESSIONAL GROUP
210 N HAMMES AVE
SUITE 103
JOLIET, IL60435-6680
 Phone: 815-725-6511
 Fax: 815-725-7166
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Mental Health

101YM0800X
Indicates primary specialty

NPI Profile & details for CENTRAL PROFESSIONAL GROUP

NPI Number 1255453056
LBN Legal business name CENTRAL PROFESSIONAL GROUP
Authorized official DAWN BENEVIDES - (BILLING SUPERVISOR)
Entity Organization
Organization subpart 1 No
Enumeration date 04/04/2007
Last updated 04/28/2009 - About 17 years ago
Identifiers
IL Medicaid 1467473462
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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