Provider Demographics
NPI:1689932733
Name:MIND OVER MATTER PSYCHIATRIC HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MIND OVER MATTER PSYCHIATRIC HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:708-229-7667
Mailing Address - Street 1:9730 S WESTERN AVE STE 712
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2826
Mailing Address - Country:US
Mailing Address - Phone:708-229-7667
Mailing Address - Fax:
Practice Address - Street 1:9730 S WESTERN AVE STE 712
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2826
Practice Address - Country:US
Practice Address - Phone:708-229-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health