MEDICARE: MINDFUL LIVING CENTER ILLINOIS JOLIET LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1487586749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL LIVING CENTER ILLINOIS JOLIET LLC

Provider Business Mailing Address
First Line	:	900 PACIFIC COAST HWY APT 105
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4859
Country	:	US
Telephone Number	:	213-510-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 N OTTAWA ST STE 245
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60432-4378
Country	:	US
Telephone Number	:	815-277-5050
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	ERIK TOLONEN
Credential	:
Telephone Number	:	213-510-7904

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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