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General NPI Number Information
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NPI Number | 1851459317
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Entity Type | Organization
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Legal Business Name | POSITIVE LIFE CENTER INC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 803 A NORTH HARLEM AVE
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City | OAK PARK
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State | IL
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Zip | 60302
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Country | US
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Telephone | 708-848-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 803 A NORTH HARLEM AVE
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City | OAK PARK
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State | IL
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Zip | 60302
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Country | US
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Telephone | 708-848-0400
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Fax |
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Authorized Official
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Title or Position | OWNER VICE PRESIDENT SECRETARY
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Name | MRS. PRISCILLA TEPE
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Credential | LMT
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Telephone | 708-848-0402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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