Nest Life Illinois, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

NEST LIFE ILLINOIS, LLC

Practice address

9560 140TH CT Apt 301
Orland Park, IL 60462-1218

Phone

(727) 201-2389

NPI assigned

Aug 27, 2021

Organization subpart

No

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

Authorized official

Name

Jennifer Phelps

Title

Ceo/Co-Founders

Phone

(727) 201-2389

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1346917119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 1ST AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337108102",
            "telephone_number": "727-201-2389",
            "fax_number": "855-224-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9560 140TH CT APT 301",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604621218",
            "telephone_number": "727-201-2389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEST LIFE ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "PHELPS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO/CO-FOUNDERS",
        "authorized_official_telephone_number": "727-201-2389"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; 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.