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General NPI Number Information
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NPI Number | 1639681653
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Entity Type | Organization
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Legal Business Name | CENTER FOR ENRICHED LIVING
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 280 SAUNDERS RD.
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City | RIVERWOODS
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State | IL
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Zip | 60015
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Country | US
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Telephone | 847-315-9888
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Fax | 847-948-7621
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Provider Business Mailing Address
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Address Line | 280 SAUNDERS RD.
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City | RIVERWOODS
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State | IL
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Zip | 60015
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Country | US
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Telephone | 847-315-9888
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Fax | 847-948-7001
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Authorized Official
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Title or Position | MANAGER OF RVFRC
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Name | EMMA LOUISE BURTON-LODER
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Credential | LCSW
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Telephone | 847-315-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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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 | 224ZF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapy Assistant
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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