Provider Demographics
NPI:1275199846
Name:GROLL THERAPY LLC
Entity Type:Organization
Organization Name:GROLL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-925-3540
Mailing Address - Street 1:4707 N OKETO AVE
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4612
Mailing Address - Country:US
Mailing Address - Phone:708-925-3540
Mailing Address - Fax:
Practice Address - Street 1:1580 N NORTHWEST HWY STE 305C
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1469
Practice Address - Country:US
Practice Address - Phone:708-925-3540
Practice Address - Fax:708-925-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-19
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health