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General NPI Number Information
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NPI Number | 1164831046
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Entity Type | Organization
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Legal Business Name | AWAKENED ALTERNATIVES INC.
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 3235 VOLLMER RD STE. 200
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2013
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Country | US
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Telephone | 708-748-1520
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Fax |
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Provider Business Mailing Address
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Address Line | 548 MARIE DR
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2232
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Country | US
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Telephone | 773-544-9380
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GENEVIEVE THOMAS
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Credential | R.N, MSN
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Telephone | 708-748-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 041335162
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 209011553
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License Number State | IL
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