Healthcare Provider Details

I. General information

NPI: 1619420320
Provider Name (Legal Business Name): KHALIL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W LAWRENCE AVE SUITE C
CHICAGO IL
60625-2958
US

IV. Provider business mailing address

999 N MAIN ST SUITE 103
GLEN ELLYN IL
60137-3581
US

V. Phone/Fax

Practice location:
  • Phone: 855-554-2545
  • Fax:
Mailing address:
  • Phone: 630-474-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. FAHAD KHAN
Title or Position: DEPUTY DIRECTOR
Credential: PSYD
Phone: 630-474-4414