Provider Demographics
NPI:1376252692
Name:INNER G RESTORATIVE & HOLISTIC CARE
Entity Type:Organization
Organization Name:INNER G RESTORATIVE & HOLISTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:847-865-6113
Mailing Address - Street 1:1626 W MONTROSE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1214
Mailing Address - Country:US
Mailing Address - Phone:312-313-8843
Mailing Address - Fax:
Practice Address - Street 1:1626 W MONTROSE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1214
Practice Address - Country:US
Practice Address - Phone:312-313-8843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center