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General NPI Number Information
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NPI Number | 1730858440
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Entity Type | Organization
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Legal Business Name | EXPANSIVE HEALTH AND RECOVERY SERVICES INC.
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 10336 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-2407
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Country | US
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Telephone | 872-985-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 2935 W 97TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2611
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Country | US
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Telephone | 872-985-7210
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. PRISCILLA EVANS
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Credential | LCSW
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Telephone | 872-985-7210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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