Ay Behavioral Health and Holistic Care Inc

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

AY BEHAVIORAL HEALTH AND HOLISTIC CARE INC

Practice address

217 Christine Way
Bolingbrook, IL 60440-6138

Phone

(773) 540-6231

NPI assigned

Oct 15, 2024

Organization subpart

No

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

Authorized official

Name

Evelyn UkpoloNPI 1891198628

Title

Owner

Phone

(773) 540-6231

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

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

• Evelyn Ukpolo, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bolingbrook, IL
  • NPI 1891198628
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1728950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1881414746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 CHRISTINE WAY",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604406138",
            "telephone_number": "773-540-6231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 CHRISTINE WAY",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604406138",
            "telephone_number": "773-540-6231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AY BEHAVIORAL HEALTH AND HOLISTIC CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-15",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "UKPOLO",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-540-6231"
    },
    "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 Bolingbrook, IL
• Providers in Bolingbrook, 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 Oct 15, 2024; 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.