Provider Demographics
NPI:1891119590
Name:RIMYA
Entity Type:Organization
Organization Name:RIMYA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:PRISSELL
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:708-465-1293
Mailing Address - Street 1:2545 W DIVERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-7172
Mailing Address - Country:US
Mailing Address - Phone:708-465-1293
Mailing Address - Fax:
Practice Address - Street 1:2545 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-7172
Practice Address - Country:US
Practice Address - Phone:708-465-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-15
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IL149016540305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.016540OtherLICENSE CLINICAL SOCIAL WORKER
ILF3001352233Medicare UPIN