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Organization

ICAN DREAM FOUNDATION INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EVISHA FORD (EXECUTIVE DIRECTOR)
(708) 307-0440
Entity
Organization

Contact information

Practice address
18501 MAPLE CREEK DR STE 200, TINLEY PARK, IL 60477-6779
(708) 307-0440
Mailing address
18501 MAPLE CREEK DR STE 200, TINLEY PARK, IL 60477-6779
(708) 307-0440

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Enumeration date
06/09/2025
Last updated
06/09/2025
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