Provider Demographics
NPI:1639681653
Name:CENTER FOR ENRICHED LIVING
Entity Type:Organization
Organization Name:CENTER FOR ENRICHED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF RVFRC
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BURTON-LODER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-315-9888
Mailing Address - Street 1:280 SAUNDERS RD.
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015
Mailing Address - Country:US
Mailing Address - Phone:847-315-9888
Mailing Address - Fax:847-948-7001
Practice Address - Street 1:280 SAUNDERS RD.
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015
Practice Address - Country:US
Practice Address - Phone:847-315-9888
Practice Address - Fax:847-948-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental ModificationGroup - Multi-Specialty
No224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & SwallowingGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty