Healthcare Provider Details

I. General information

NPI: 1568040186
Provider Name (Legal Business Name): SENIOR CARE THERAPY OF ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 W ARTHUR AVE
LINCOLNWOOD IL
60712-3843
US

IV. Provider business mailing address

85 CRESCENT AVE
PASSAIC NJ
07055-2437
US

V. Phone/Fax

Practice location:
  • Phone: 973-264-0023
  • Fax:
Mailing address:
  • Phone: 973-264-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALISA ROSENFELD
Title or Position: OWNER
Credential: LCSW
Phone: 973-264-0023