MEDICARE: INSTITUTE FOR THE CYCLES OF LIFE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149014340	IL

General Provider Information

NPI Number	:	1417495680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR THE CYCLES OF LIFE LLC

Provider Business Mailing Address
First Line	:	12 E BROOKWOOD DR
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-2512
Country	:	US
Telephone Number	:	734-846-7535
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 E BROOKWOOD DR
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-2512
Country	:	US
Telephone Number	:	734-846-7535
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEB NAOMI TORRES
Credential	:
Telephone Number	:	734-846-7535

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	04/28/2017

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