NPIMap

Organization Active NPI

Community Wellness Center, LLC

  • Health Educator
  • Shorewood, IL
National Provider Identifier
1174912166
Registry record updated Jan 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
License
227.013688 Issued in IL
Legal business name
COMMUNITY WELLNESS CENTER, LLC
Practice address
863 Center CT
Suite a
Shorewood, IL 60404-8511
Phone
(815) 404-0003
NPI assigned
Jan 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2015

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

Authorized official

Name
Ms. Richelle Peterson, LMT
Title
Owner
Phone
(815) 404-0003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health EducatorGroup: 193200000X MULTI-SPECIALTY GROUP 174H00000X 227.013688 IL Primary

Addresses

Primary practice location

863 Center CT
Suite a
Shorewood, IL 60404-8511

Mailing address

863 Center CT
Suite a
Shorewood, IL 60404-8511
Phone (815) 404-0003

National Provider Directory

National Provider Directory

Locations

863 Center Ct
Unit A
Shorewood, IL 60404
Phone (505) 412-9185

NPI Registry JSON

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

{
    "created_epoch": "1421193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421193600000",
    "number": "1174912166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "863 CENTER CT",
            "address_2": "SUITE A",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604048511",
            "telephone_number": "815-404-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "863 CENTER CT",
            "address_2": "SUITE A",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604048511",
            "telephone_number": "815-404-0003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-14",
        "last_updated": "2015-01-14",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "RICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-404-0003",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": "IL",
            "license": "227.013688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shorewood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; 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.