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General NPI Number Information
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NPI Number | 1295504959
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Entity Type | Organization
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Legal Business Name | HEART OF ROSE PSYCHIATRY LLC
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Dates
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Enumeration Date | 12/22/2023
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 20200 GOVERNORS DR STE 328
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1032
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Country | US
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Telephone | 773-657-9003
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Fax | 773-648-8443
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Provider Business Mailing Address
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Address Line | 6006 COLGATE LN
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City | MATTESON
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State | IL
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Zip | 60443-1995
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | MR. BROWN EHIS
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Credential | PMHNP
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Telephone | 773-716-6869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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