MEDICARE: TOTAL ENRICHMENT SERVICES INC.-NFP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1033921408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL ENRICHMENT SERVICES INC.-NFP

Provider Business Mailing Address
First Line	:	4922 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3142
Country	:	US
Telephone Number	:	773-403-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	4922 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3142
Country	:	US
Telephone Number	:	773-403-1162
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. CHRISTOPHER C JACKSON
Credential	:
Telephone Number	:	773-680-9699

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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