Dynasty 57 Behavioral Health LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

DYNASTY 57 BEHAVIORAL HEALTH LLC

Practice address

2206 W Greenleaf Ave
Chicago, IL 60645-4804

Phone

(773) 234-1067

NPI assigned

Dec 15, 2025

Organization subpart

No

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

Authorized official

Name

Modupe Ojuetimi OlukeyeNPI 1295301315

Title

Owner

Phone

(773) 234-1067

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Modupe Ojuetimi Olukeye, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1295301315
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1765756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1689538563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2206 W GREENLEAF AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606454804",
            "telephone_number": "773-234-1067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2206 W GREENLEAF AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606454804",
            "telephone_number": "773-234-1067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNASTY 57 BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-15",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "OLUKEYE",
        "authorized_official_first_name": "MODUPE",
        "authorized_official_middle_name": "OJUETIMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-234-1067"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.