Provider Demographics
NPI:1952035255
Name:JIMARE WELLNESS, INC
Entity Type:Organization
Organization Name:JIMARE WELLNESS, INC
Other - Org Name:JIMARE WELLNESS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:708-391-5505
Mailing Address - Street 1:6238 26TH ST UNIT 305
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-5402
Mailing Address - Country:US
Mailing Address - Phone:708-391-5505
Mailing Address - Fax:708-433-4441
Practice Address - Street 1:5915 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2136
Practice Address - Country:US
Practice Address - Phone:708-391-5505
Practice Address - Fax:708-433-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty