Provider Demographics
NPI:1134935596
Name:BENRACH MENTAL WELLNESS CENTER LLC
Entity type:Organization
Organization Name:BENRACH MENTAL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC/ NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:OLABISI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-431-8475
Mailing Address - Street 1:1011 E TOUHY AVE STE 555
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5824
Mailing Address - Country:US
Mailing Address - Phone:224-955-2199
Mailing Address - Fax:
Practice Address - Street 1:1011 E TOUHY AVE STE 555
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-5824
Practice Address - Country:US
Practice Address - Phone:224-955-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty