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General NPI Number Information
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NPI Number | 1366026858
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Entity Type | Organization
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Legal Business Name | CONDOR LIFE SERVICES, LLC
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 100 SAUNDERS RD STE 150
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City | LAKE FOREST
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State | IL
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Zip | 60045-2526
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Country | US
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Telephone | 833-955-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SAUNDERS RD STE 150
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City | LAKE FOREST
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State | IL
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Zip | 60045-2526
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Country | US
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Telephone | 833-955-5888
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | CAROLE CRAWFORD
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Credential |
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Telephone | 312-961-9469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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