Provider Demographics
NPI:1174897292
Name:KENNETH YOUNG CENTER
Entity type:Organization
Organization Name:KENNETH YOUNG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-524-8800
Mailing Address - Street 1:1001 ROHLWING RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3217
Mailing Address - Country:US
Mailing Address - Phone:847-524-8800
Mailing Address - Fax:847-524-8824
Practice Address - Street 1:1 ILLINOIS BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3314
Practice Address - Country:US
Practice Address - Phone:847-524-8800
Practice Address - Fax:847-524-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201209261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL583690Medicare PIN
IL201209Medicare PIN