Provider Demographics
NPI:1073388104
Name:ADEWELL HOLISTIC HEALTH & MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:ADEWELL HOLISTIC HEALTH & MEDICAL CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP-C, PMHNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:ADERONKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHIBAJO
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:847-610-9400
Mailing Address - Street 1:1833 HICKS RD STE D
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1247
Mailing Address - Country:US
Mailing Address - Phone:847-610-9400
Mailing Address - Fax:847-572-2170
Practice Address - Street 1:1833 HICKS RD STE D
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1247
Practice Address - Country:US
Practice Address - Phone:847-610-9400
Practice Address - Fax:847-572-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty