Organization
COMPREHENSIVE HEALTH AGENCY NURTURING GUEST ENERVATION
Active
Other names
C.H.A.N.G.E. OF Illinois
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY KENNER WASH (DIRECTOR)
(708) 331-2679
Entity
Organization
Contact information
Practice address
14719 HALSTED ST, HARVEY, IL 60426-1920
(708) 331-2679
Mailing address
14719 HALSTED ST, HARVEY, IL 60426-1920
(708) 331-2679
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.006944
IL
163W00000X
Registered Nurse
041.106435
IL
171M00000X
Case Manager/Care Coordinator
—
—
208D00000X
General Practice Physician
036.109938
IL
Other
Enumeration date
08/14/2008
Last updated
08/14/2008
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