1366783797 NPI number — ACE THERAPY SERVICES OF ILLINOIS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366783797 NPI number — ACE THERAPY SERVICES OF ILLINOIS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACE THERAPY SERVICES OF ILLINOIS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366783797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10345 DEARLOVE RD
Provider Second Line Business Mailing Address:
UNIT 102
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60025-3666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-219-7308
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7105 VIRGINIA RD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014-7985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-219-7308
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PEPITO
Authorized Official First Name:
LOVELEI
Authorized Official Middle Name:
CIARA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
815-219-7308

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  070-017839 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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