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General NPI Number Information
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NPI Number | 1477952562
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Entity Type | Organization
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Legal Business Name | ARDENT COMMUNITY WELLNESS CENTER
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 3166 N LINCOLN AVE SUITE 401
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City | CHICAGO
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State | IL
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Zip | 60657-3133
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Country | US
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Telephone | 630-473-3091
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Fax |
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Provider Business Mailing Address
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Address Line | 684 S BARRINGTON RD STUITE 112
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City | STREAMWOOD
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State | IL
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Zip | 60107-1841
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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 | EXECUTIVE DIRECTOR
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Name | STEPHEN BAYNES
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Credential |
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Telephone | 630-473-3091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 15018
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License Number State | IL
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