Provider Demographics
NPI:1285387431
Name:REVERENCE BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:REVERENCE BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKWETEY
Authorized Official - Middle Name:MENSAH
Authorized Official - Last Name:AKRONG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:630-864-5775
Mailing Address - Street 1:539 ROOSEVELT RD # 1050
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5734
Mailing Address - Country:US
Mailing Address - Phone:630-864-5775
Mailing Address - Fax:
Practice Address - Street 1:1415 WEST 22ND STREET TOWER FLOOR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-864-5775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty