1689797276 NPI number — OF SOUND MIND, INC.

Table of content: (NPI 1689797276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689797276 NPI number — OF SOUND MIND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OF SOUND MIND, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689797276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5215 N RAVENSWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60640-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-907-8825
Provider Business Mailing Address Fax Number:
773-907-8841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5215 N RAVENSWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-907-8825
Provider Business Practice Location Address Fax Number:
773-907-8841
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFO
Authorized Official First Name:
LORI
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
773-907-8825

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 276614 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 237540 . This is a "COMPSYCH CORP." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P-12036740 . This is a "MULTIPLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com