Provider Demographics
NPI:1326820325
Name:SPIRIT OF WELLNESS REIKI CENTER LLC
Entity Type:Organization
Organization Name:SPIRIT OF WELLNESS REIKI CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:708-685-2101
Mailing Address - Street 1:2210 N 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3037
Mailing Address - Country:US
Mailing Address - Phone:224-388-8569
Mailing Address - Fax:
Practice Address - Street 1:261 N YORK ST STE 102
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2757
Practice Address - Country:US
Practice Address - Phone:708-685-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care