MEDICARE: AGENTS OF HOPE TRAINING& INFORMATION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1487231338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGENTS OF HOPE TRAINING& INFORMATION CENTER

Provider Business Mailing Address
First Line	:	6412 N DAMEN AVE APT 3E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5627
Country	:	US
Telephone Number	:	773-943-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	6412 N DAMEN AVE APT 3E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5627
Country	:	US
Telephone Number	:	773-943-1172
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	HODAN A AHMED
Credential	:	MHP
Telephone Number	:	773-943-1172

Provider Enumeration Date	:	03/26/2021
Last Update Date	:	03/26/2021

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