Healthcare Provider Details

I. General information

NPI: 1851107007
Provider Name (Legal Business Name): OHR HEALTH AND WELLNESS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 WATERSIDE DR
SOUTH ELGIN IL
60177-3718
US

IV. Provider business mailing address

783 WATERSIDE DR
SOUTH ELGIN IL
60177-3718
US

V. Phone/Fax

Practice location:
  • Phone: 847-909-3196
  • Fax:
Mailing address:
  • Phone: 847-909-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAYA ROBERT LUIS
Title or Position: OWNER
Credential: NP
Phone: 847-909-3196