Healthcare Provider Details

I. General information

NPI: 1235898057
Provider Name (Legal Business Name): PREVENTION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 N HOYNE AVE APT 306
CHICAGO IL
60659-2130
US

IV. Provider business mailing address

6350 N HOYNE AVE APT 306
CHICAGO IL
60659-2130
US

V. Phone/Fax

Practice location:
  • Phone: 773-302-5348
  • Fax:
Mailing address:
  • Phone: 773-302-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED JALEEL
Title or Position: PRESIDENT
Credential:
Phone: 773-302-5348