Provider Demographics
NPI:1972934610
Name:CENTER FOR VITALITY AND BALANCE, LLC
Entity Type:Organization
Organization Name:CENTER FOR VITALITY AND BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MS
Authorized Official - Phone:630-286-0993
Mailing Address - Street 1:1280 IROQUOIS AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8570
Mailing Address - Country:US
Mailing Address - Phone:630-286-0993
Mailing Address - Fax:
Practice Address - Street 1:1280 IROQUOIS AVE STE 404
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8570
Practice Address - Country:US
Practice Address - Phone:630-286-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008297305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service