Organization
CULTIVATE BEHAVIORAL HEALTH AND EDUCATION- ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OZZIE HOLMGREN M.ED., BCBA (REGIONAL VICE PRESIDENT)
(631) 804-4268
Entity
Organization
Contact information
Practice address
11055 S NAGLE AVE APT 5, WORTH, IL 60482-1655
(224) 703-0502
Mailing address
11055 S NAGLE AVE APT 5, WORTH, IL 60482-1655
(224) 703-0502
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
12/06/2020
Last updated
12/06/2020
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