Provider Demographics
NPI:1417067596
Name:INNERPEACE NATURAL HEALTHCARE
Entity Type:Organization
Organization Name:INNERPEACE NATURAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-773-2373
Mailing Address - Street 1:1002 INFANTRY DRIVE #E
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3010
Mailing Address - Country:US
Mailing Address - Phone:815-773-2373
Mailing Address - Fax:815-773-2374
Practice Address - Street 1:1002 INFANTRY DRIVE
Practice Address - Street 2:#E
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3010
Practice Address - Country:US
Practice Address - Phone:815-773-2373
Practice Address - Fax:815-773-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0170213387174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL017021387OtherSTATE OF ILLINOIS