Healthcare Provider Details

I. General information

NPI: 1124073143
Provider Name (Legal Business Name): GLOBAL COMMUNITY MENTAL HEALTH CENTER SE SUB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 183RD ST SUITE # 300
HOMEWOOD IL
60430-2804
US

IV. Provider business mailing address

3011 183RD ST SUITE # 300
HOMEWOOD IL
60430-2804
US

V. Phone/Fax

Practice location:
  • Phone: 708-720-6609
  • Fax: 708-748-6180
Mailing address:
  • Phone: 708-720-6609
  • Fax: 708-748-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036055245
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036055245
License Number StateIL

VIII. Authorized Official

Name: ANWAR S YAMINI
Title or Position: C.E.O.
Credential:
Phone: 708-720-6609