Provider Demographics
NPI:1659135416
Name:BEVERLY PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:BEVERLY PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:NYENKE
Authorized Official - Suffix:
Authorized Official - Credentials:APN, PMHNP-BC
Authorized Official - Phone:312-857-4475
Mailing Address - Street 1:10406 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2508
Mailing Address - Country:US
Mailing Address - Phone:312-857-4475
Mailing Address - Fax:773-666-7241
Practice Address - Street 1:10406 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2508
Practice Address - Country:US
Practice Address - Phone:312-857-4475
Practice Address - Fax:773-666-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty