Provider Demographics
NPI:1720897333
Name:180 WHOLE HEALTH, LLC
Entity type:Organization
Organization Name:180 WHOLE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:773-800-6714
Mailing Address - Street 1:837 N LOMBARD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1430
Mailing Address - Country:US
Mailing Address - Phone:773-800-6714
Mailing Address - Fax:
Practice Address - Street 1:837 N LOMBARD AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1430
Practice Address - Country:US
Practice Address - Phone:773-800-6714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty