Healthcare Provider Details

I. General information

NPI: 1477258655
Provider Name (Legal Business Name): NOURISHING HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/24/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 W. HUBBARD
CHICAGO IL
60622
US

IV. Provider business mailing address

1716 W. HUBBARD
CHICAGO IL
60622
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-1777
  • Fax: 773-525-7310
Mailing address:
  • Phone: 773-525-1777
  • Fax: 773-525-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLIE O'CONNELL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 773-525-1777