Nine Forty Cullom Corporation

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

License

0017178 Issued in IL

Legal business name

NINE FORTY CULLOM CORPORATION

Doing business as

Mado Healthcare - Buena Park

Practice address

940 W Cullom Ave
Chicago, IL 60613

Phone

(773) 525-9000

Fax

(773) 525-8016

NPI assigned

Nov 4, 2005

Last updated

Apr 15, 2019By 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

Mr. Peter J Obrien

Title

President

Phone

(312) 787-9400

Specialties & licenses 1

Addresses

Other names 1

• MADO HEALTHCARE - BUENA PARK Doing business as

Locations

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555286400000",
    "number": "1912998188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N WABASH AVE STE P2W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113541",
            "telephone_number": "312-787-9400",
            "fax_number": "312-787-9434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 W CULLOM AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60613",
            "telephone_number": "773-525-9000",
            "fax_number": "773-525-8016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NINE FORTY CULLOM CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2019-04-15",
        "status": "A",
        "authorized_official_last_name": "OBRIEN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-787-9400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "IL",
            "license": "0017178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADO HEALTHCARE - BUENA PARK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Nimrod, LCPC
• Thomas Joseph Nimrod
• Nina Arora, DDS, P.C.
• Nina Logan Jenner Psychotherapy PLLC
• Boney Mattathethu Ninan, M.D
• Ravee Ningsanond
• Teodora Lilyancheva Ninkovska, FNP-BC
• June C Ninnemann, LCSW
• Angela Nino, LSW
• Ninth Incarnation, LLC

• Mental Illness Intermediate Care Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Mental Illness Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; 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.