MEDICARE: JANELLE CHARISE RUSH

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1548041015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE CHARISE RUSH

Provider Business Mailing Address
First Line	:	1241 W LOYOLA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-5193
Country	:	US
Telephone Number	:	177-396-4860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 W LOYOLA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-5193
Country	:	US
Telephone Number	:	177-396-4860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	10/11/2023

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