NPIMap

Organization Active NPI

Advanced Life Providers

  • Health Educator
  • Matteson, IL
National Provider Identifier
1114450707
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
License
041348482 Issued in IL
Legal business name
ADVANCED LIFE PROVIDERS
Practice address
239 Willow Rd
Matteson, IL 60443-1068
Phone
(847) 830-7385
NPI assigned
Apr 10, 2017
Last updated
Apr 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

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

Authorized official

Name
La Tonya Lee Rafe, RN
Title
Ceo
Phone
(847) 830-7385

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health EducatorGroup: 193200000X MULTI-SPECIALTY GROUP 174H00000X 041348482 IL Primary

Addresses

Primary practice location

239 Willow Rd
Matteson, IL 60443-1068

Mailing address

239 Willow Rd
Matteson, IL 60443-1068
Phone (847) 830-7385

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1114450707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 WILLOW RD",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604431068",
            "telephone_number": "847-830-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 WILLOW RD",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604431068",
            "telephone_number": "847-830-7385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED LIFE PROVIDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "RAFE",
        "authorized_official_first_name": "LA TONYA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-830-7385",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": "IL",
            "license": "041348482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matteson, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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.