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General NPI Number Information
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NPI Number | 1326876525
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Entity Type | Organization
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Legal Business Name | LOVE MANIA CLUB
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 613 E 50TH ST APT 2C
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City | CHICAGO
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State | IL
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Zip | 60615-2597
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Country | US
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Telephone | 773-629-7477
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Fax |
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Provider Business Mailing Address
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Address Line | 613 E 50TH ST APT 2C
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City | CHICAGO
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State | IL
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Zip | 60615-2597
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Country | US
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Telephone | 773-629-7477
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BEUNKA BUTLER
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Credential | CADC, CHW, BA
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Telephone | 773-629-7477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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