Embodied Change, Inc

LBN: Embodied Change, Inc
Embodied Change, Inc is an health care organization with primary practice located at 4055 W Peterson Ave Ste 104 , Chicago IL 60646-6183. The organization recently has 2 registered licenses in different health care specialties including Agencies / Community/Behavioral Health, Ambulatory Health Care Facilities / Adult Mental Health. Agencies / Community/Behavioral Health is the primary health care specialty. Embodied Change, Inc can be contacted via phone (773) 726-7290, or through Ryan Stock, Mollie via phone (773) 726-7290.

Contact Information

Primary practice address
4055 W Peterson Ave Ste 104 Chicago IL 60646-6183
Phone: (773) 726-7290
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Ryan Stock, Mollie LCPC
Phone: (773) 726-7290

Health care specialties

SpecialtyCodeLicense #State
Agencies / Community/Behavioral Health 251S00000X
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X

Profile Details

NPI number 1730656000
LBN Legal business name Embodied Change, Inc
DBA Doing business as
Authorized official Ryan Stock, Mollie LCPC
Entity Organization
Organization subpart 1 No
Enumeration date Oct 25th, 2018
Last updated Mar 25th, 2019 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730656000 NPPES
Illinois MEDICAID 1316219892

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