Provider Demographics
NPI:1366254286
Name:BETHMIA FOUNDATION
Entity type:Organization
Organization Name:BETHMIA FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOJISOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYORINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-849-8787
Mailing Address - Street 1:2450 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6038
Mailing Address - Country:US
Mailing Address - Phone:630-849-8787
Mailing Address - Fax:630-566-2622
Practice Address - Street 1:17516 E CARRIAGEWAY DR STE B
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2079
Practice Address - Country:US
Practice Address - Phone:630-849-8787
Practice Address - Fax:630-566-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty