Organization
DYNASTY 57 BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MODUPE OJUETIMI OLUKEYE (OWNER)
(773) 234-1067
Entity
Organization
Contact information
Practice address
2206 W GREENLEAF AVE, CHICAGO, IL 60645-4804
(773) 234-1067
Mailing address
2206 W GREENLEAF AVE, CHICAGO, IL 60645-4804
(773) 234-1067
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/15/2025
Last updated
12/16/2025
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