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General NPI Number Information
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NPI Number | 1679995526
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Entity Type | Organization
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Legal Business Name | BOLINGBROOK MEMORY CARE, LLC
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 351 LILY CACHE LN
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3441
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Country | US
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Telephone | 630-759-0797
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Fax | 630-759-1075
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Provider Business Mailing Address
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Address Line | 545 E JOHN CARPENTER FWY SUITE 500
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City | IRVING
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State | TX
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Zip | 75062-3931
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Country | US
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Telephone | 214-845-4500
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Fax | 214-845-4501
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Authorized Official
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Title or Position | VP OF MANAGEMENT--SL
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Name | FELICHIA FIELDS
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Credential |
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Telephone | 214-845-4454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 5104283
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License Number State | IL
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