Provider Demographics
NPI:1144851684
Name:GREYWOOD HEALTH CENTER LLC
Entity type:Organization
Organization Name:GREYWOOD HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER/EXECUTIVE DIRECTOR/CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:YOVANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-923-5642
Mailing Address - Street 1:640 N WELLS ST APT 703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3733
Mailing Address - Country:US
Mailing Address - Phone:609-923-5642
Mailing Address - Fax:
Practice Address - Street 1:303 W INSTITUTE PL FL 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3080
Practice Address - Country:US
Practice Address - Phone:312-952-2396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty