MEDICARE: RETAKE ON LIFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1295379279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETAKE ON LIFE

Provider Business Mailing Address
First Line	:	8008 S LOOMIS BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-3828
Country	:	US
Telephone Number	:	773-998-7848
Fax Number	:

Provider Business Practice Location Address
First Line	:	9415 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-6700
Country	:	US
Telephone Number	:	773-998-7848
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLIN PROF COUNSELOR
Name	:	JAMILLAH DAVIS
Credential	:	LCPC
Telephone Number	:	773-998-7848

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/01/2019

Similar Medicare Providers

1558765164 — SULAIMON KEHINDE OLADIPO
Practice Location Address:

9415 S WESTERN AVE STE 206
CHICAGO, IL
60643-6700

Practice Phone: 773-301-8464
Practice Fax: 773-530-2643

1023126273 — MR. PHILIP L WARE LCSW
Practice Location Address:

9415 S WESTERN AVE
CHICAGO, IL
60643-6700

Practice Phone: 708-337-5433
Practice Fax: 708-210-1430

1043404023 — WELLNESS HOME CARE, INC.
Practice Location Address:

9415 S WESTERN AVE , SUITE 109
CHICAGO, IL
60643-6700

Practice Phone: 773-779-8815
Practice Fax: 773-779-8875

1659511426 — ALICE JEAN GIBSON LCPC
Practice Location Address:

9415 S WESTERN AVE , SUITE 117
CHICAGO, IL
60643-6700

Practice Phone: 773-297-2401
Practice Fax:

1689077455 — ATRIUM HEALTHCARE SERVICES LLC
Practice Location Address:

9415 S WESTERN AVE # 110
CHICAGO, IL
60643-6700

Practice Phone: 773-445-4550
Practice Fax: 773-445-4555

1255064291 — LEGACY CORE HEALTH LLC
Practice Location Address:

9415 S WESTERN AVE STE 235
CHICAGO, IL
60643-6700

Practice Phone: 708-321-1233
Practice Fax:

Directions to “RETAKE ON LIFE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.