Healthcare Provider Details

I. General information

NPI: 1508220088
Provider Name (Legal Business Name): BOBBY E WRIGHT CBHC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 07/21/2022
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5090 W HARRISON ST
CHICAGO IL
60644-5141
US

IV. Provider business mailing address

5002 W MADISON ST
CHICAGO IL
60644-4127
US

V. Phone/Fax

Practice location:
  • Phone: 773-722-7900
  • Fax: 773-722-0644
Mailing address:
  • Phone: 773-722-7900
  • Fax: 773-722-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: SIMONE EDWARDS
Title or Position: CFO
Credential:
Phone: 773-722-7900