Enliven Wellness Center LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

227009901 Issued in IL

Legal business name

ENLIVEN WELLNESS CENTER LLC

Practice address

118 N Clinton St
Suite 102
Chicago, IL 60661-2386

Phone

(773) 738-7146

Fax

(312) 488-4628

NPI assigned

Jul 21, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ruby Botello, LMT, RMTNPI 1558773077

Title

President

Phone

(773) 738-7146

Specialties & licenses 1

Addresses

Other names 1

• Massage Evolved Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ruby Botello, LMT

  • Massage Therapist
  • Chicago, IL
  • NPI 1558773077
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1003223157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 N CLINTON ST",
            "address_2": "SUITE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606612386",
            "telephone_number": "773-738-7146",
            "fax_number": "312-488-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 N CLINTON ST",
            "address_2": "SUITE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606612386",
            "telephone_number": "773-738-7146",
            "fax_number": "312-488-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENLIVEN WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "BOTELLO",
        "authorized_official_first_name": "RUBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-738-7146",
        "authorized_official_credential": "LMT, RMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227009901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Massage Evolved",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Massage Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.