Provider Demographics
NPI:1770046575
Name:HEALTHY LIFE, LLC
Entity Type:Organization
Organization Name:HEALTHY LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-495-8165
Mailing Address - Street 1:2729 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1930
Mailing Address - Country:US
Mailing Address - Phone:248-495-8165
Mailing Address - Fax:
Practice Address - Street 1:200 W MADISON ST STE 2100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3521
Practice Address - Country:US
Practice Address - Phone:248-495-8165
Practice Address - Fax:773-353-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service