Organization
BENNU HEALTH SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY GRAY-WHITE M.D. (PRESIDENT)
(773) 354-7572
Entity
Organization
Contact information
Practice address
2617 W 71ST ST, CHICAGO, IL 60629-2003
(773) 354-7572
Mailing address
1125A E HYDE PARK BLVD, CHICAGO, IL 60615-2809
(773) 354-7572
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
IL
Other
Enumeration date
04/22/2007
Last updated
08/22/2020
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