| Autumn Healthcare Of Illinois | |
|
4505 S Drexel Blvd Chicago IL 60653-4301 | |
| (773) 285-0550 | |
| Not Available |
| Full Name | Autumn Healthcare Of Illinois |
|---|---|
| Speciality | Counselor |
| Location | 4505 S Drexel Blvd, Chicago, Illinois |
| Authorized Official Name and Position | Pamela Ann Brazelton-sykes (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7734203481 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Autumn Healthcare Of Illinois 9449 S Kedzie Ave Ste142 Evergreen Park IL 60805-2325 Ph: (773) 420-3481 | Autumn Healthcare Of Illinois 4505 S Drexel Blvd Chicago IL 60653-4301 Ph: (773) 285-0550 |
| NPI Number | 1679628705 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 01/31/2019 |
| Medicare PECOS PAC ID | 5991607624 |
|---|---|
| Medicare Enrollment ID | O20040123000202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679628705 | NPI | - | NPPES |
| 1487709697 | Other | IL | NPI |
| 207655 | Other | IL | NO TITLE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Annie W Hudson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710185764 PECOS PAC ID: 7113989294 Enrollment ID: I20041101000566 |
| Provider Name | Steven E Hurley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548339955 PECOS PAC ID: 3870699275 Enrollment ID: I20070501000590 |
| Provider Name | Lisa Lindsey Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336529866 PECOS PAC ID: 1557672805 Enrollment ID: I20150612001912 |
| Provider Name | Claudette Shunice Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528561032 PECOS PAC ID: 2567724578 Enrollment ID: I20180402001195 |
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