Provider Demographics
NPI:1629478599
Name:GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC
Entity Type:Organization
Organization Name:GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC
Other - Org Name:A RAY OF HOPE: THE GREAT LAKES INSTITUTE OF NEUROLOGY AND PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-816-6441
Mailing Address - Street 1:1860 W WINCHESTER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5312
Mailing Address - Country:US
Mailing Address - Phone:847-816-6335
Mailing Address - Fax:847-816-6355
Practice Address - Street 1:1860 W WINCHESTER RD STE 106
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5312
Practice Address - Country:US
Practice Address - Phone:847-816-6335
Practice Address - Fax:847-816-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361334252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty