MEDICARE: RESILIENT LIVING, 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1861148322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENT LIVING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 35142
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-0142
Country	:	US
Telephone Number	:	773-600-3930
Fax Number	:

Provider Business Practice Location Address
First Line	:	4952 W ROSCOE ST UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4337
Country	:	US
Telephone Number	:	773-600-3930
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	TANIA E NUNEZ
Credential	:	LCPC
Telephone Number	:	773-600-3930

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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