KING COMMUNITY MENTAL HEALTH CENTER CORP (NPI# 1003056557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003056557 |
| Entity Type | Organization |
| Organization Name | KING COMMUNITY MENTAL HEALTH CENTER CORP |
| Practice Address |
4455 S King Drive Suite 101 Chicago IL 60653-3310 |
| Practice Telephone | 7735362700 |
| Practice Fax Number | 7737512250 |
| Mailing Telephone | 7735362700 |
| Mailing Fax Number | 7737512250 |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2009-06-25 |
| Authorized Official Name | DR. ROUEEN RAFEYAN (OWNER) |
| Authorized Official Telephone | 7735362700 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
036089152 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
4455 S KING DRIVE SUITE 101 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60653-3310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881215804 | Pamela Ann Brazelton-sykes | Counselor | Pioneer Gardens Supportive Living, 3800 S King Dr, Chicago, IL 60653 | 2020-04-30 |
| 1962915439 | Pickup Transport Lllp | Non-emergency Medical Transport (VAN) | 4418 S. Oakenwald Ave, Chicago, IL 60653 | 2017-11-07 |
| 1245758309 | Qi Wellness LLC | Case Management | 525 E 46th Place, Chicago, IL 60653 | 2017-09-08 |
| 1598202897 | Fadesire O Ajuwon | Registered Nurse | 4218 S King Dr, 1n, Chicago, IL 60653 | 2017-01-24 |
| 1013464619 | Roundys Supermarkets Inc | Pharmacy | 3857 S Dr Martin Luther King Jr Dr, Chicago, IL 60653 | 2016-09-01 |
| 1417384793 | Griffin Orthodontics PC | Dentist | 1040 E 47th Street, Chicago, IL 60653 | 2013-10-02 |
| 1114350659 | Carita Dale Johnson | Pharmacist | 3753 S. Cottage Grove Ave, 104, Chicago, IL 60653 | 2013-08-20 |
| 1245677848 | Mercy Diagnostic and Treatment Center | Clinic/Center | 3755 S Cottage Grove, Chicago, IL 60653 | 2013-05-23 |
| 1952745937 | Mercy Community Pharmacy At Oakwood Shores | Pharmacy | 3753 S. Cottage Grove, Chicago, IL 60653 | 2013-04-22 |
| 1386952315 | Jami S Little | Developmental Therapist | 617 East 41st, Chicago, IL 60653 | 2010-09-24 |
| Find all providers in zip 60653 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831714294 | Kaitlin E Keenan | Psychiatry & Neurology | 600 S Paulina St Ste 403aac, Chicago, IL 60612-3806 | 2020-06-11 |
| 1285195594 | Niccolo Emanuele Mencacci | Psychiatry & Neurology | 303 E Chicago Ave # 12-226, Chicago, IL 60611-4296 | 2019-03-28 |
| 1497216865 | Juan Pablo Ospina Botero | Psychiatry & Neurology | 5841 S Maryland Ave # 2030s231, Chicago, IL 60637-1443 | 2019-03-28 |
| 1780164574 | Danielle Trokey | Psychiatry & Neurology | 2515 N Clark St Ste 801, Chicago, IL 60614 | 2018-08-21 |
| 1124526272 | Neurology Clinic of Chicago, LLC | Psychiatry & Neurology | 4909 W Division St Ste 302, Chicago, IL 60651-3161 | 2018-01-23 |
| 1538514120 | Kathleen Mary Gorman | Psychiatry & Neurology | 225 E Chicago Avenue, Chicago, IL 60611 | 2016-05-02 |
| 1396190203 | Lauren Brandes | Psychiatry & Neurology | 1725 W Harrison St Ste 309, Chicago, IL 60612-3844 | 2016-04-28 |
| 1366838708 | Tresa Elizabeth Zacharias | Psychiatry & Neurology | Northwestern University, 710 N. Lake Shore Drive, Chicago, IL 60611 | 2015-04-13 |
| 1588059570 | Neena R Cherayil | Psychiatry & Neurology | 259 E Erie St Fl 19, Chicago, IL 60611-2987 | 2015-04-06 |
| 1851782783 | Jennifer Ann Smith | Psychiatry & Neurology | 240 East Huron Street, Mcgaw Pavilion, Suite 1-203, Office of Graduate Medical Education, Chicago, IL 60611 | 2015-02-13 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.