Healthcare Provider Details

I. General information

NPI: 1679819734
Provider Name (Legal Business Name): LIFECORE REHAB AND COUNSELING SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11536 183RD PL
ORLAND PARK IL
60467-9493
US

IV. Provider business mailing address

8051 186TH ST
TINLEY PARK IL
60487-9341
US

V. Phone/Fax

Practice location:
  • Phone: 708-960-4023
  • Fax: 708-991-7275
Mailing address:
  • Phone: 708-342-7076
  • Fax: 708-342-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number036131268
License Number StateIL

VIII. Authorized Official

Name: ASIM FAROOQI
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 708-342-7076