Healthcare Provider Details

I. General information

NPI: 1578150264
Provider Name (Legal Business Name): PARTNERS IN HOPE INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048B SAGAMORE PKWY W # 1004
WEST LAFAYETTE IN
47906-1446
US

IV. Provider business mailing address

415 W GOLF RD STE 26
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 708-840-3733
  • Fax:
Mailing address:
  • Phone: 224-777-8034
  • Fax: 224-236-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: YUSUF SALAH
Title or Position: PRESIDENT
Credential: MD
Phone: 224-777-8034