Provider Demographics
NPI:1396400883
Name:ROCKWELL BEHAVIORAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ROCKWELL BEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-381-9352
Mailing Address - Street 1:5214 N WESTERN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2588
Mailing Address - Country:US
Mailing Address - Phone:708-381-9352
Mailing Address - Fax:
Practice Address - Street 1:5214 N WESTERN AVE STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2588
Practice Address - Country:US
Practice Address - Phone:708-381-9352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)