Provider Demographics
NPI:1790443505
Name:AMARAK MEDICAL & BEHAVIORAL HEALTH SERVICES P C
Entity Type:Organization
Organization Name:AMARAK MEDICAL & BEHAVIORAL HEALTH SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOLUKE
Authorized Official - Middle Name:I
Authorized Official - Last Name:OMOYENI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP -C
Authorized Official - Phone:773-510-6687
Mailing Address - Street 1:26605 LINDENGATE CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5878
Mailing Address - Country:US
Mailing Address - Phone:773-510-6687
Mailing Address - Fax:
Practice Address - Street 1:26605 LINDENGATE CIR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5878
Practice Address - Country:US
Practice Address - Phone:773-510-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty