Provider Demographics
NPI:1174686083
Name:NEW FOUNDATION CENTER, INC,
Entity Type:Organization
Organization Name:NEW FOUNDATION CENTER, INC,
Other - Org Name:WILPOWER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-501-2839
Mailing Address - Street 1:444 W FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3009
Mailing Address - Country:US
Mailing Address - Phone:847-501-2939
Mailing Address - Fax:847-501-4803
Practice Address - Street 1:444 W FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3009
Practice Address - Country:US
Practice Address - Phone:847-501-2939
Practice Address - Fax:847-501-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632232OtherBCBS