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General NPI Number Information
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NPI Number | 1720770159
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Entity Type | Organization
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Legal Business Name | GREAT MINDS HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 850 BURNHAM AVE
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City | CALUMET CITY
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State | IL
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Zip | 60409-4707
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Country | US
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Telephone | 708-381-9943
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Fax |
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Provider Business Mailing Address
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Address Line | 9631 S CICERO AVE # 1587
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City | OAK LAWN
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State | IL
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Zip | 60453-3137
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Country | US
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Telephone | 708-381-9943
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ERNEST OGBEIDE
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Credential |
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Telephone | 708-381-9943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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