Healthcare Provider Details

I. General information

NPI: 1437579620
Provider Name (Legal Business Name): ARDENT COMMUNITY WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2014
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W HIGGINS RD STE 105
HOFFMAN ESTATES IL
60169-2040
US

IV. Provider business mailing address

684 S BARRINGTON RD SUITE 112
STREAMWOOD IL
60107-1841
US

V. Phone/Fax

Practice location:
  • Phone: 888-870-1775
  • Fax:
Mailing address:
  • Phone: 888-870-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number15018
License Number StateIL

VIII. Authorized Official

Name: STEPHEN BAYNES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 888-870-1775