Provider Demographics
NPI:1891252078
Name:ESSENCE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:ESSENCE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TESLIM
Authorized Official - Middle Name:O
Authorized Official - Last Name:OPAKUNLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-692-7791
Mailing Address - Street 1:10449 VENICE LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8218
Mailing Address - Country:US
Mailing Address - Phone:708-692-7791
Mailing Address - Fax:
Practice Address - Street 1:10449 VENICE LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8218
Practice Address - Country:US
Practice Address - Phone:708-692-7791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1922487370Medicaid