AUTUMN HEALTHCARE OF ILLINOIS (NPI# 1679628705) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679628705 |
| Entity Type | Organization |
| Organization Name | AUTUMN HEALTHCARE OF ILLINOIS |
| Practice Address |
4505 S Drexel Blvd Chicago IL 60653-4301 |
| Mailing Address |
9449 S Kedzie Ave Ste142 Evergreen Park IL 60805-2325 |
| Practice Telephone | 7732850550 |
| Mailing Telephone | 7734203481 |
| Mailing Fax Number | 7734203597 |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2019-01-31 |
| Authorized Official Name | MS. PAMELA ANN BRAZELTON-SYKES (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7734203481 |
| Authorized Official Credential | MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | NPI | 1487709697 | 01 |
| IL | NO TITLE | 207655 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205317377 | Autumn Healthcare of Illinois | Clinic/Center | 9449 S Kedzie Ave, Suite 142, Evergreen Pk, IL 60805-2325 | 2018-08-27 |
| Street Address |
4505 S DREXEL BLVD |
| City | CHICAGO |
| State | IL |
| Zip Code | 60653-4301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316559933 | Nina Marie Deffala | Speech-Language Pathologist | 4505 S Drexel Blvd, Chicago, IL 60653-4301 | 2020-08-17 |
| 1942830542 | Alan Lei | Occupational Therapist | 4505 S Drexel Blvd, Chicago, IL 60653-4301 | 2020-01-22 |
| 1609331966 | Jackelyn Sheree Jones | Occupational Therapist | 4505 S Drexel Blvd, Chicago, IL 60653-4301 | 2019-01-31 |
| 1396228227 | Callie Wilbat | Speech-Language Pathologist | 4505 S Drexel Blvd, Chicago, IL 60653-4301 | 2018-09-06 |
| 1457896920 | Allan Boquiren | Nurse Practitioner | 4505 S Drexel Blvd, Chicago, IL 60653-4301 | 2016-12-20 |
| 1669887394 | Estates of Hyde Park LLC | Skilled Nursing Facility | 4505 S Drexel Blvd, Chicago, IL 60653-4301 | 2014-06-20 |
| 1285956813 | Avenue Care Nursing and Rehabilitation Center LLC | Skilled Nursing Facility | 4505 S Drexel Blvd, Chicago, IL 60653-4301 | 2010-02-24 |
| 1558406926 | Avenue Care Center | Skilled Nursing Facility | 4505 S Drexel Blvd, Chicago, IL 60653-4301 | 2007-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881215804 | Pamela Ann Brazelton-sykes | Counselor | Pioneer Gardens Supportive Living, 3800 S King Dr, Chicago, IL 60653 | 2020-04-30 |
| 1962915439 | Pickup Transport Lllp | Non-emergency Medical Transport (VAN) | 4418 S. Oakenwald Ave, Chicago, IL 60653 | 2017-11-07 |
| 1245758309 | Qi Wellness LLC | Case Management | 525 E 46th Place, Chicago, IL 60653 | 2017-09-08 |
| 1598202897 | Fadesire O Ajuwon | Registered Nurse | 4218 S King Dr, 1n, Chicago, IL 60653 | 2017-01-24 |
| 1013464619 | Roundys Supermarkets Inc | Pharmacy | 3857 S Dr Martin Luther King Jr Dr, Chicago, IL 60653 | 2016-09-01 |
| 1417384793 | Griffin Orthodontics PC | Dentist | 1040 E 47th Street, Chicago, IL 60653 | 2013-10-02 |
| 1114350659 | Carita Dale Johnson | Pharmacist | 3753 S. Cottage Grove Ave, 104, Chicago, IL 60653 | 2013-08-20 |
| 1245677848 | Mercy Diagnostic and Treatment Center | Clinic/Center | 3755 S Cottage Grove, Chicago, IL 60653 | 2013-05-23 |
| 1952745937 | Mercy Community Pharmacy At Oakwood Shores | Pharmacy | 3753 S. Cottage Grove, Chicago, IL 60653 | 2013-04-22 |
| 1386952315 | Jami S Little | Developmental Therapist | 617 East 41st, Chicago, IL 60653 | 2010-09-24 |
| Find all providers in zip 60653 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730780602 | Saba Aqel | Counselor | 107 W Van Buren St Ste 215, Chicago, IL 60605-1054 | 2020-11-05 |
| 1538768155 | Angelicare LLC | Counselor | 6650 N Northwest Hwy Ste 215, Chicago, IL 60631-1363 | 2020-10-23 |
| 1013516145 | Modern Soul Therapy LLC | Counselor | 2000 N Racine Ave Ste 2160, Chicago, IL 60614-4045 | 2020-10-20 |
| 1477151942 | Mansukh Sandhu | Counselor | 8765 W Higgins Rd Ste 450, Chicago, IL 60631-4172 | 2020-10-15 |
| 1881291920 | Freddy Reyes | Counselor | 931 W Leland Ave Apt 405, Chicago, IL 60640-6611 | 2020-10-01 |
| 1508463704 | Tynisha Jointer | Counselor | 7710 S Saint Lawrence Ave, Chicago, IL 60619-2925 | 2020-10-01 |
| 1851908206 | Manqual Chambers | Counselor | 2801 S King Dr, Chicago, IL 60616-2949 | 2020-09-29 |
| 1184231672 | Francesca Cottone | Counselor | 1616 N Nordica Ave, Chicago, IL 60707-4317 | 2020-09-28 |
| 1952916322 | Elle Skelton | Counselor | 2219 N Seeley Ave Apt 3f, Chicago, IL 60647-3363 | 2020-09-13 |
| 1437764305 | Donita M Lester | Counselor | 7022 S South Shore Dr Apt 214, Chicago, IL 60649-2229 | 2020-09-09 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.