NPI 1740543305

The Otherside a Behavioral Healthcare Corp

Organisation Community/Behavioral Health Agency Urbana, IL

Practice location

Address: 1717 Philo Rd Suite 23, Urbana, IL 61802-6044
Phone: (217) 607-0098
Fax: (217) 298-0142

Authorised official

Name: Leonard Eugene Deforge
Title: Owner/Manager
Phone: (217) 607-0098

Registered specialties

Community/Behavioral Health Agency Primary

Agencies Taxonomy 251S00000X

Other Community/Behavioral Health providers in Illinois →

Registry record

NPI: 1740543305
Entity type: Organization
NPI issued: 19 Jun 2012
Record last updated: 20 Jun 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.