Provider Demographics
NPI:1235460189
Name:CORE CENTERS, LLC
Entity Type:Organization
Organization Name:CORE CENTERS, LLC
Other - Org Name:COMPREHENSIVE OBESITY RECOVERY EFFORT CENTERS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONVISER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-540-9955
Mailing Address - Street 1:205 N MICHIGAN AVE
Mailing Address - Street 2:STE. 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5927
Mailing Address - Country:US
Mailing Address - Phone:312-540-9955
Mailing Address - Fax:312-540-0944
Practice Address - Street 1:205 N MICHIGAN AVE
Practice Address - Street 2:STE. 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5927
Practice Address - Country:US
Practice Address - Phone:312-540-9955
Practice Address - Fax:312-540-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004492103TB0200X
IL071005162103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty