Healthcare Provider Details

I. General information

NPI: 1437966462
Provider Name (Legal Business Name): FAMPAC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 GOVERNORS DR FL 3
OLYMPIA FIELDS IL
60461-1032
US

IV. Provider business mailing address

20200 GOVERNORS DR FL 3
OLYMPIA FIELDS IL
60461-1032
US

V. Phone/Fax

Practice location:
  • Phone: 312-530-9977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: DR. MICHELLE-ANN RHODEN-NEITA
Title or Position: CEO
Credential: PHD
Phone: 312-530-9977