1639681653 NPI number — CENTER FOR ENRICHED LIVING

Table of content: (NPI 1639681653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639681653 NPI number — CENTER FOR ENRICHED LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ENRICHED LIVING
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:
1639681653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 SAUNDERS RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERWOODS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-315-9888
Provider Business Mailing Address Fax Number:
847-948-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 SAUNDERS RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERWOODS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-315-9888
Provider Business Practice Location Address Fax Number:
847-948-7621
Provider Enumeration Date:
10/31/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURTON-LODER
Authorized Official First Name:
EMMA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
MANAGER OF RVFRC
Authorized Official Telephone Number:
847-315-9888

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 224ZE0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224ZF0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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