Provider Demographics
NPI:1467042283
Name:MADEINA WELLNESS
Entity Type:Organization
Organization Name:MADEINA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RAMALAXMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANMUGAVELAYUTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-908-0447
Mailing Address - Street 1:3049 W GRACE ST # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4539
Mailing Address - Country:US
Mailing Address - Phone:630-908-0447
Mailing Address - Fax:
Practice Address - Street 1:3049 W GRACE ST # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4539
Practice Address - Country:US
Practice Address - Phone:630-908-0447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)