Healthcare Provider Details

I. General information

NPI: 1720897333
Provider Name (Legal Business Name): 180 WHOLE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 N LOMBARD AVE
OAK PARK IL
60302-1430
US

IV. Provider business mailing address

837 N LOMBARD AVE
OAK PARK IL
60302-1430
US

V. Phone/Fax

Practice location:
  • Phone: 773-800-6714
  • Fax:
Mailing address:
  • Phone: 773-800-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JIMMIE E RUSHING
Title or Position: OWNER
Credential: BCBA
Phone: 773-800-6714