Provider Demographics
NPI:1821447798
Name:SUPERIOR INTERVENTIONS,LLC
Entity Type:Organization
Organization Name:SUPERIOR INTERVENTIONS,LLC
Other - Org Name:ELMHURST INTERVENTIONS,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:OZARK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:630-932-8809
Mailing Address - Street 1:5729 ROSE CT
Mailing Address - Street 2:NONE
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1548
Mailing Address - Country:US
Mailing Address - Phone:708-805-7235
Mailing Address - Fax:630-563-9197
Practice Address - Street 1:1 S 132 SUMMIT AVENUE
Practice Address - Street 2:SUITE 108
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-1548
Practice Address - Country:US
Practice Address - Phone:630-932-8809
Practice Address - Fax:630-563-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-7154-0001-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health