Provider Demographics
NPI:1396526737
Name:COMPLETE CARE BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:COMPLETE CARE BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SENAMI
Authorized Official - Middle Name:OLUBUNMI
Authorized Official - Last Name:EDALERE-LUKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-983-7028
Mailing Address - Street 1:440 W BOUGHTON RD STE E
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 W BOUGHTON RD STE E
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2391
Practice Address - Country:US
Practice Address - Phone:813-997-2099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty