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General NPI Number Information
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NPI Number | 1295607356
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Entity Type | Organization
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Legal Business Name | PUREPOWER HEALTH LLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 14489 JOHN HUMPHREY DR STE 207A
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City | ORLAND PARK
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State | IL
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Zip | 60462-2671
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Country | US
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Telephone | 708-980-3563
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Fax |
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Provider Business Mailing Address
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Address Line | 14489 JOHN HUMPHREY DR STE 207A
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City | ORLAND PARK
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State | IL
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Zip | 60462-2671
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Country | US
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Telephone | 708-980-3563
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Fax |
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Authorized Official
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Title or Position | CO-CEO
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Name | RAMA F MUSTAFA
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Credential |
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Telephone | 708-980-3563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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