Provider Demographics
NPI:1831499359
Name:LIFE IN BALANCE HEALTHCARE & WELLNESS, INC.
Entity Type:Organization
Organization Name:LIFE IN BALANCE HEALTHCARE & WELLNESS, INC.
Other - Org Name:LIFE IN BALANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:E
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-787-4443
Mailing Address - Street 1:4 E OGDEN AVE # 344
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3506
Mailing Address - Country:US
Mailing Address - Phone:866-787-4443
Mailing Address - Fax:866-787-4443
Practice Address - Street 1:4 E OGDEN AVE # 344
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-3506
Practice Address - Country:US
Practice Address - Phone:866-787-4443
Practice Address - Fax:866-787-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490130251041C0700X
207RE0101X, 2084P0805X, 208800000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty