Provider Demographics
NPI:1548781297
Name:ILLINOIS THERAPEUTIC & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:ILLINOIS THERAPEUTIC & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:630-877-8277
Mailing Address - Street 1:605 HALEY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-3942
Mailing Address - Country:US
Mailing Address - Phone:630-877-8277
Mailing Address - Fax:
Practice Address - Street 1:605 HALEY MEADOWS DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-3942
Practice Address - Country:US
Practice Address - Phone:630-877-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation