Organization Active NPI

Heart of Rose Psychiatry LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Olympia Fields, IL
National Provider Identifier
1295504959
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
HEART OF ROSE PSYCHIATRY LLC
Practice address
20200 Governors Dr Ste 328
Olympia Fields, IL 60461-1032
Phone
(773) 657-9003
Fax
(773) 648-8443
NPI assigned
Dec 22, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brown Ehis, PMHNP
Title
Pmhnp
Phone
(773) 716-6869

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

20200 Governors Dr Ste 328
Olympia Fields, IL 60461-1032

Mailing address

6006 Colgate LN
Matteson, IL 60443-1995

National Provider Directory

National Provider Directory

Locations

20200 Governors Dr
Ste 328
Olympia Flds, IL 60461
Phone (773) 657-9003

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1295504959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6006 COLGATE LN",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604431995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20200 GOVERNORS DR STE 328",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611032",
            "telephone_number": "773-657-9003",
            "fax_number": "773-648-8443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF ROSE PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-22",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "EHIS",
        "authorized_official_first_name": "BROWN",
        "authorized_official_title_or_position": "PMHNP",
        "authorized_official_telephone_number": "773-716-6869",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.