MIDWEST BRAIN INJURY CLUBHOUSE (NPI# 1669876033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669876033 |
| Entity Type | Organization |
| Organization Name | MIDWEST BRAIN INJURY CLUBHOUSE |
| Practice Address |
1436 W Randolph St Suite 500 Chicago IL 60607-1405 |
| Practice Telephone | 3122268714 |
| Practice Fax Number | 3122268722 |
| Mailing Telephone | 3122268714 |
| Mailing Fax Number | 3122268722 |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2015-06-22 |
| Authorized Official Name | TAMMIKO BESS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3122268714 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275647315 | Midwest Brain Injury Clubhouse | Voluntary or Charitable | 1010 N Hooker St, #302, Chicago, IL 60622-4549 | 2006-08-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MIDWEST BRAIN INJURY CLUBHOUSE, THE | 300 N Elizabeth St Ste 310c, Chicago, IL 60607-1130 |
| Street Address |
1436 W RANDOLPH ST SUITE 500 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60607-1405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588933188 | Julie Demes | Speech-Language Pathologist | 1436 W Randolph St, Suite 204, Chicago, IL 60607-1405 | 2011-12-28 |
| 1467858761 | Melody Maney | Occupational Therapist | 1436 W Randolph St, Chicago, IL 60607-1405 | 2014-11-13 |
| 1053737957 | Julie Marie Conrad | Occupational Therapist | 1436 W Randolph St, 204, Chicago, IL 60607-1405 | 2014-03-15 |
| 1407295868 | Emily Margaret Geline | Occupational Therapist | 1436 W Randolph St, Suite 204, Chicago, IL 60607-1405 | 2013-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992349237 | Portia Dowd | Registered Nurse | 140 N Ashland, Chicago, IL 60607 | 2019-10-30 |
| 1114577210 | Joseph Matthew Thiel | Emergency Medical Technician, Intermediate | 558 West De Koven, Chicago, IL 60607 | 2019-09-19 |
| 1215585757 | Highland Park Cvs LLC | Durable Medical Equipment & Medical Supplies | 1034 West Lake St, Chicago, IL 60607 | 2019-08-28 |
| 1003462821 | Michael Marek Maka | Psychologist | 820 W. Jackson Blvd, Suite 515, Chicago, IL 60607 | 2019-08-16 |
| 1558922344 | Kellie Meyer | Speech-Language Pathologist | Eyas Landing West Loop, 1409 W. Carroll Ave, Chicago, IL 60607 | 2019-06-24 |
| 1811460108 | Corinna House | Social Worker | 932 W Washington, Chicago, IL 60607 | 2019-01-09 |
| 1962979518 | Louise Taussig Bush | Counselor | 1142 West Madison Street, Suite 406, Chicago, IL 60607 | 2018-10-31 |
| 1568941318 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1051 W Randolph, Chicago, IL 60607 | 2018-08-13 |
| 1851883425 | Alefiyah Zulfiqar Pishori | Psychologist | 1200 West Harrison St, Chicago, IL 60607 | 2018-05-30 |
| 1679062954 | Elizabeth R Rolston | Physical Therapist | 24 S Morgan St Ste 100, Chicago, IL 60607 | 2018-05-02 |
| Find all providers in zip 60607 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336753896 | Counseling Kennedy Shenberg | Community/Behavioral Health | 5752 N Campbell Ave Apt 1, Chicago, IL 60659-5080 | 2020-09-02 |
| 1700498573 | Bobby E. Wright Comprehensive Behavioral Health Center, Inc. | Community/Behavioral Health | 5816 W Division St Fl 1, Chicago, IL 60651-1003 | 2020-08-21 |
| 1164030557 | Acorn & Oak Counseling Pllc | Community/Behavioral Health | 1333 W Devon Ave Ste 319, Chicago, IL 60660-1329 | 2020-07-21 |
| 1144848300 | Marathon Mindset Counseling LLC | Community/Behavioral Health | 1650 W Adams St Apt 304, Chicago, IL 60612-3209 | 2020-07-13 |
| 1417586678 | Invisions Behavioral Health LLC | Community/Behavioral Health | 8211 S Woodlawn Ave, Chicago, IL 60619-4519 | 2020-04-08 |
| 1871124784 | Nurture Therapy, LLC | Community/Behavioral Health | 3711 N Ravenswood Ave Ste 146, Chicago, IL 60613-5944 | 2020-01-29 |
| 1962032086 | Bucktown Therapy | Community/Behavioral Health | 1820 W Webster Ave Ste 200, Chicago, IL 60614-2934 | 2020-01-16 |
| 1770121436 | Guided Expressions LLC | Community/Behavioral Health | 6640 S University Ave Apt 2, Chicago, IL 60637-4320 | 2019-12-12 |
| 1063058279 | Y Not Families | Community/Behavioral Health | 6427 S Ashland Ave, Chicago, IL 60636-2716 | 2019-11-22 |
| 1073156196 | Black Tie Therapy | Community/Behavioral Health | 2232 N Wayne Ave Apt 1f, Chicago, IL 60614-8937 | 2019-10-21 |
| 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.