Organization
LIGHT OF HOPE MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TANJDRA LASANDRA ROUSE LPN (CEO)
(708) 735-3405
Entity
Organization
Contact information
Practice address
16401 PLYMOUTH DR, MARKHAM, IL 60428-4738
(708) 735-3405
Mailing address
16401 PLYMOUTH DR, MARKHAM, IL 60428-4738
(708) 735-3405
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
174200000X
Meals Provider
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/03/2021
Last updated
12/03/2021
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