Provider Demographics
NPI:1255952255
Name:AGE WISE CARE MANAGEMENT INC.
Entity type:Organization
Organization Name:AGE WISE CARE MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CRC, CCM
Authorized Official - Phone:217-493-3086
Mailing Address - Street 1:101 W TOMARAS AVE STE 5152
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9547
Mailing Address - Country:US
Mailing Address - Phone:217-493-3086
Mailing Address - Fax:888-456-5007
Practice Address - Street 1:101 W TOMARAS AVE STE 5152
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9547
Practice Address - Country:US
Practice Address - Phone:217-493-3086
Practice Address - Fax:888-456-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health