Healthcare Provider Details

I. General information

NPI: 1619622685
Provider Name (Legal Business Name): VERDURE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 N DILLEYS RD STE 210
GURNEE IL
60031-1721
US

IV. Provider business mailing address

1761 N DILLEYS RD STE 210
GURNEE IL
60031-1721
US

V. Phone/Fax

Practice location:
  • Phone: 224-419-5053
  • Fax:
Mailing address:
  • Phone: 224-419-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENISHA L.C. FOREMAN
Title or Position: OWNER
Credential: LCPC
Phone: 224-637-6999