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NPI Code Detail

MEDICARE: ASD LIFE INC.

MEDICARE: ASD LIFE INC.
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
1251C00000XDevelopmentally Disabled Services Day Training Agency1-15-20882IL
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1427405745
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASD LIFE INC.
Provider Business Mailing Address
First Line : 11301 S HARLEM AVE
Second Line :
City : WORTH
State : IL
Zip : 60482-2001
Country : US
Telephone Number : 630-631-9623
Fax Number : 866-823-8780
Provider Business Practice Location Address
First Line : 11301 S HARLEM AVE
Second Line :
City : WORTH
State : IL
Zip : 60482-2001
Country : US
Telephone Number : 708-586-2604
Fax Number : 866-823-8780
Authorized Official
Title or Position : CEO
Name : RANIA MUHEISEN
Credential :
Telephone Number : 630-754-6314
Provider Enumeration Date : 05/17/2016
Last Update Date : 01/28/2025

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