Provider Demographics
NPI:1447048426
Name:ENSOLEILLE BEHAVIORAL HEALTH INC
Entity type:Organization
Organization Name:ENSOLEILLE BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIALLO-FOFANA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN/FPA
Authorized Official - Phone:708-943-7915
Mailing Address - Street 1:4861 W CATALPA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1513
Mailing Address - Country:US
Mailing Address - Phone:773-430-8745
Mailing Address - Fax:
Practice Address - Street 1:840 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:708-943-7915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty