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General NPI Number Information
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NPI Number | 1790472355
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Entity Type | Organization
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Legal Business Name | 1863FWD CARE 2 CARE NFP
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 243 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-1375
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Country | US
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Telephone | 708-491-3303
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 717
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City | GLENWOOD
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State | IL
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Zip | 60425-0717
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Country | US
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Telephone | 708-491-3303
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JATAUN ROLLINS
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Credential | LCSW
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Telephone | 708-491-3303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State |
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Taxonomy #2
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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 #3
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #7
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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 |
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