Ibukun Comprehensive Community Services, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

180004168 Issued in IL

Legal business name

IBUKUN COMPREHENSIVE COMMUNITY SERVICES, INC.

Practice address

6752 S Perry Ave
Chicago, IL 60621-3714

Phone

(773) 994-6125

Fax

(773) 994-6135

NPI assigned

Oct 24, 2011

Last updated

Oct 24, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Christian Akiwowo, PH.D.

Title

Executive Director

Phone

(773) 994-6125

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1319414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319414400000",
    "number": "1386920221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6752 S PERRY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213714",
            "telephone_number": "773-994-6125",
            "fax_number": "773-994-6135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6752 S PERRY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213714",
            "telephone_number": "773-994-6125",
            "fax_number": "773-994-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IBUKUN COMPREHENSIVE COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-24",
        "last_updated": "2011-10-24",
        "status": "A",
        "authorized_official_last_name": "AKIWOWO",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-994-6125",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "IL",
            "license": "180004168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Chicago, IL
• Providers in Chicago, IL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; 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.