Provider Demographics
NPI:1558005322
Name:RONNELS MIND BODY AND MENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:RONNELS MIND BODY AND MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENEDETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWUMEH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,PMHNP,FNP
Authorized Official - Phone:708-288-1099
Mailing Address - Street 1:1155 183RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3507
Mailing Address - Country:US
Mailing Address - Phone:708-288-1099
Mailing Address - Fax:
Practice Address - Street 1:1155 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3507
Practice Address - Country:US
Practice Address - Phone:708-288-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health