Healthcare Provider Details

I. General information

NPI: 1295607356
Provider Name (Legal Business Name): PUREPOWER HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14489 JOHN HUMPHREY DR STE 207A
ORLAND PARK IL
60462-2671
US

IV. Provider business mailing address

14489 JOHN HUMPHREY DR STE 207A
ORLAND PARK IL
60462-2671
US

V. Phone/Fax

Practice location:
  • Phone: 708-980-3563
  • Fax:
Mailing address:
  • Phone: 708-980-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAMA F MUSTAFA
Title or Position: CO-CEO
Credential:
Phone: 708-980-3563