=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699632968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMABLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2026
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 232 GENTRY ST
-----------------------------------------------------
City | PARK FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60466-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-770-6136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 232 GENTRY ST
-----------------------------------------------------
City | PARK FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60466-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-770-6136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SIMISOLA ABAYOMI
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 708-770-6136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------