Bolingbrook Memory Care, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5104283 Issued in IL

Legal business name

BOLINGBROOK MEMORY CARE, LLC

Doing business as

Autumn Leaves of Bolingbrook

Practice address

351 Lily Cache LN
Bolingbrook, IL 60440-3441

Phone

(630) 759-0797

Fax

(630) 759-1075

NPI assigned

Jan 13, 2014

Last updated

Jan 13, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Felichia Fields

Title

VP of Management--SL

Phone

(214) 845-4454

Specialties & licenses 1

Addresses

Other names 1

• Autumn Leaves of Bolingbrook Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389571200000",
    "number": "1679995526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 E JOHN CARPENTER FWY",
            "address_2": "SUITE 500",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750623931",
            "telephone_number": "214-845-4500",
            "fax_number": "214-845-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 LILY CACHE LN",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403441",
            "telephone_number": "630-759-0797",
            "fax_number": "630-759-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLINGBROOK MEMORY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-13",
        "last_updated": "2014-01-13",
        "status": "A",
        "authorized_official_last_name": "FIELDS",
        "authorized_official_first_name": "FELICHIA",
        "authorized_official_title_or_position": "VP OF MANAGEMENT--SL",
        "authorized_official_telephone_number": "214-845-4454"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": "5104283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Leaves of Bolingbrook",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Bolingbrook Healthcare Associates S.C.
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• Bolingbrook Pediatrics, SC
• Bolingbrook Pharmacy Inc
• Bolingbrook Taxi and Limousine Co
• Bolingbrook Urgent Care LLC
• Bolingbrook Vision Source Inc.

• Assisted Living Facility in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.