=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033876586
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HYD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2021
-----------------------------------------------------
Last Update Date | 11/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 369 E IRVING PARK RD
-----------------------------------------------------
City | WOOD DALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60191-1642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-739-7014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 369 E IRVING PARK RD
-----------------------------------------------------
City | WOOD DALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60191-1642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JALEEL AHMED MOHAMMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-739-7014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------