Provider Demographics
NPI:1922419365
Name:WANG BEHAVIORAL HEALTHCARE S.C.
Entity Type:Organization
Organization Name:WANG BEHAVIORAL HEALTHCARE S.C.
Other - Org Name:ASCENSION BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CERTIFIED PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-439-2883
Mailing Address - Street 1:1005 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2713
Mailing Address - Country:US
Mailing Address - Phone:708-439-2883
Mailing Address - Fax:312-328-7808
Practice Address - Street 1:1005 E 61ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2713
Practice Address - Country:US
Practice Address - Phone:708-439-2883
Practice Address - Fax:312-328-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361316922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty