Provider Demographics
NPI:1578057634
Name:MELANIE DEL MUNDO, LTD
Entity Type:Organization
Organization Name:MELANIE DEL MUNDO, LTD
Other - Org Name:MELANIE DEL MUNDO, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL MUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-593-5032
Mailing Address - Street 1:440 W COLFAX ST
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2537
Mailing Address - Country:US
Mailing Address - Phone:312-593-5032
Mailing Address - Fax:
Practice Address - Street 1:1608 W COLONIAL PKWY STE 203
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4755
Practice Address - Country:US
Practice Address - Phone:312-593-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004300261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)