Provider Demographics
NPI:1861874604
Name:HELENE DOSS
Entity type:Organization
Organization Name:HELENE DOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSR RECOVERY SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-573-4922
Mailing Address - Street 1:1813 N HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403
Mailing Address - Country:US
Mailing Address - Phone:815-573-4922
Mailing Address - Fax:
Practice Address - Street 1:1813 N HICKORY ST
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-2541
Practice Address - Country:US
Practice Address - Phone:815-573-4922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-28
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)