Provider Demographics
NPI:1720770159
Name:GREAT MINDS HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:GREAT MINDS HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-381-9943
Mailing Address - Street 1:9631 S CICERO AVE # 1587
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3137
Mailing Address - Country:US
Mailing Address - Phone:708-381-9943
Mailing Address - Fax:
Practice Address - Street 1:9631 S CICERO AVE # 1587
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3137
Practice Address - Country:US
Practice Address - Phone:708-381-9943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty