DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: AUTUMN HEALTHCARE OF ILLINOIS

MEDICARE: AUTUMN HEALTHCARE OF ILLINOIS
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11487709697OTHERILNPI
2207655OTHERILNO TITLE

General Provider Information

NPI Number : 1679628705
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTUMN HEALTHCARE OF ILLINOIS
Provider Business Mailing Address
First Line : 9449 S KEDZIE AVE
Second Line : STE142
City : EVERGREEN PARK
State : IL
Zip : 60805-2325
Country : US
Telephone Number : 773-420-3481
Fax Number : 773-420-3597
Provider Business Practice Location Address
First Line : 4505 S DREXEL BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4301
Country : US
Telephone Number : 773-285-0550
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. PAMELA ANN BRAZELTON-SYKES
Credential : MS
Telephone Number : 773-420-3481
Provider Enumeration Date : 01/25/2007
Last Update Date : 04/23/2025

Similar Medicare Providers

1558406926 — AVENUE CARE CENTER
Practice Location Address:
4505 S DREXEL BLVD
CHICAGO, IL
60653-4301
Practice Phone: 773-285-0550
Practice Fax:
1285956813 — AVENUE CARE NURSING AND REHABILITATION CENTER LLC
Practice Location Address:
4505 S DREXEL BLVD
CHICAGO, IL
60653-4301
Practice Phone: 773-285-0550
Practice Fax: 773-285-5618
1669887394 — ESTATES OF HYDE PARK LLC
Practice Location Address:
4505 S DREXEL BLVD
CHICAGO, IL
60653-4301
Practice Phone: 773-285-0550
Practice Fax:
1457896920 — MR. ALLAN BOQUIREN MSN
Practice Location Address:
4505 S DREXEL BLVD
CHICAGO, IL
60653-4301
Practice Phone: 773-285-0550
Practice Fax:
1396228227 — CALLIE WILBAT CF-SLP
Practice Location Address:
4505 S DREXEL BLVD
CHICAGO, IL
60653-4301
Practice Phone: 773-285-0550
Practice Fax:
1609331966 — MS. JACKELYN SHEREE JONES OTR
Practice Location Address:
4505 S DREXEL BLVD
CHICAGO, IL
60653-4301
Practice Phone: 773-285-0550
Practice Fax:

Directions to “AUTUMN HEALTHCARE OF ILLINOIS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.