Healthcare Provider Details

I. General information

NPI: 1326408816
Provider Name (Legal Business Name): ESTABLISHING, MANGING AND GENERATING EFFECTIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 79TH ST
CHICAGO IL
60619-2302
US

IV. Provider business mailing address

110 E 79TH ST
CHICAGO IL
60619-2302
US

V. Phone/Fax

Practice location:
  • Phone: 773-224-7386
  • Fax: 773-224-7685
Mailing address:
  • Phone: 773-224-7386
  • Fax: 773-224-7685

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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number001230000
License Number StateIL

VIII. Authorized Official

Name: DR. HATTIE WASH
Title or Position: FOUNDER/CEO
Credential: PSY.D.
Phone: 773-224-7386