Provider Demographics
NPI:1659998326
Name:BALANCED HEALTH
Entity Type:Organization
Organization Name:BALANCED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAAL
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLEWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-718-5468
Mailing Address - Street 1:1614 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1614 MAIN ST APT D
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1688
Practice Address - Country:US
Practice Address - Phone:515-718-5468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251E00000XAgenciesHome Health
No305S00000XManaged Care OrganizationsPoint of Service