Healthcare Provider Details

I. General information

NPI: 1538810155
Provider Name (Legal Business Name): AND RISE WOMEN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 W BYRON ST
CHICAGO IL
60641-2622
US

IV. Provider business mailing address

5123 W BYRON ST
CHICAGO IL
60641-2622
US

V. Phone/Fax

Practice location:
  • Phone: 773-733-3411
  • Fax:
Mailing address:
  • Phone: 773-733-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JENNIFER RAMIREZ
Title or Position: FOUNDER AND EXECUTIVE DIRECTOR
Credential:
Phone: 773-733-3411