MEDICARE: GJS HOPE LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1912602384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GJS HOPE LLC

Provider Business Mailing Address
First Line	:	1384 FOREST AVE
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-6046
Country	:	US
Telephone Number	:	708-541-5596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1384 FOREST AVE
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-6046
Country	:	US
Telephone Number	:	708-541-5596
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST, CEO
Name	:	DR. GARNADETTE STUCKEY
Credential	:
Telephone Number	:	708-541-5596

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/04/2023

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Directions to “GJS HOPE LLC ” Practice Location

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