Provider Demographics
NPI:1508378191
Name:LILIUM THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:LILIUM THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC- SLP
Authorized Official - Phone:770-549-8882
Mailing Address - Street 1:5405 FRIPP LN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8051
Mailing Address - Country:US
Mailing Address - Phone:770-549-8882
Mailing Address - Fax:
Practice Address - Street 1:7961 HIGHWAY 92 STE 100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5209
Practice Address - Country:US
Practice Address - Phone:770-549-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty