Healthcare Provider Details

I. General information

NPI: 1720973084
Provider Name (Legal Business Name): ICAN DREAM FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18501 MAPLE CREEK DR STE 200
TINLEY PARK IL
60477-6779
US

IV. Provider business mailing address

18501 MAPLE CREEK DR STE 200
TINLEY PARK IL
60477-6779
US

V. Phone/Fax

Practice location:
  • Phone: 708-307-0440
  • Fax:
Mailing address:
  • Phone: 708-307-0440
  • 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. EVISHA FORD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 708-307-0440