Provider Demographics
NPI:1861458697
Name:ASSAULT & ABUSE SERVICES OF STEPHENSON COUNTY
Entity type:Organization
Organization Name:ASSAULT & ABUSE SERVICES OF STEPHENSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:815-232-8179
Mailing Address - Street 1:222 WEST SPRING ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4321
Mailing Address - Country:US
Mailing Address - Phone:815-232-7200
Mailing Address - Fax:815-232-8470
Practice Address - Street 1:222 WEST SPRING ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4321
Practice Address - Country:US
Practice Address - Phone:815-232-7200
Practice Address - Fax:815-232-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)