Cultivate Behavioral Health and Education- Illinois

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

CULTIVATE BEHAVIORAL HEALTH AND EDUCATION- ILLINOIS

Practice address

11055 S Nagle Ave Apt 5
Worth, IL 60482-1655

Phone

(224) 703-0502

NPI assigned

Dec 6, 2020

Last updated

Dec 6, 2020By 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

Ozzie Holmgren, M.ED., BCBA

Title

Regional Vice President

Phone

(631) 804-4268

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ashley Marie Eppenstein, BCBA

  • Behavior Analyst
  • Bee Cave, TX
  • NPI 1083277289
  NPD

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

{
    "created_epoch": "1607212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607212800000",
    "number": "1467058404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11055 S NAGLE AVE APT 5",
            "city": "WORTH",
            "state": "IL",
            "postal_code": "604821655",
            "telephone_number": "224-703-0502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11055 S NAGLE AVE APT 5",
            "city": "WORTH",
            "state": "IL",
            "postal_code": "604821655",
            "telephone_number": "224-703-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CULTIVATE BEHAVIORAL HEALTH AND EDUCATION- ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-06",
        "last_updated": "2020-12-06",
        "certification_date": "2020-12-06",
        "status": "A",
        "authorized_official_last_name": "HOLMGREN",
        "authorized_official_first_name": "OZZIE",
        "authorized_official_title_or_position": "REGIONAL VICE PRESIDENT",
        "authorized_official_telephone_number": "631-804-4268",
        "authorized_official_credential": "M.ED., BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Christensen, BCBA
• Mark Brian Colander, O.D,
• Completely Chiropractic, LTD.
• Eric Corrao, PHARMD
• Creek Point Dental
• Daniel T Bodine DDS PC
• Alice Daniels, M.D.
• Margaret Anne Davidson
• Michael Don Destefano, M.D.
• Jasmine Dobbs, RN, FNP-C

• Behavior Analyst in Worth, IL
• Providers in Worth, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2020; 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.