Active NPI
Fourcorners Wellness Center, LTD
- Clinical Social Worker
- Loves Park, IL
National Provider Identifier
1932968633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Legal business name
- FOURCORNERS WELLNESS CENTER, LTD
- Practice address
- 4001 N Perryville Rd
Loves Park, IL 61111-8644 - Phone
- (815) 988-4370
- NPI assigned
- Mar 15, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kevin M Polky, LCSW
- Title
- Founder/President
- Phone
- (815) 988-4370
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
4001 N Perryville Rd
Loves Park, IL 61111-8644
Mailing address
4001 N Perryville Rd
Loves Park, IL 61111-8644
Phone (815) 988-4370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
4001 N Perryville Rd
Loves Park, IL 61111
Phone (815) 374-8887
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Social Worker
- Rockford, IL
- NPI 1902094469
-
- Clinical Social Worker
- Rockford, IL
- NPI 1871292995
-
- Clinical Social Worker
- Rockford, IL
- NPI 1750075677
-
- Professional Counselor
- Rockford, IL
- NPI 1154803070
-
- Professional Counselor
- Lombard, IL
- NPI 1730820036
-
- Professional Counselor
- Rockford, IL
- NPI 1083189120
-
- Professional Counselor
- Rockford, IL
- NPI 1710259759
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710460800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1710460800000",
"number": "1932968633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4001 N PERRYVILLE RD",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611118644",
"telephone_number": "815-988-4370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 N PERRYVILLE RD",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611118644",
"telephone_number": "815-988-4370"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOURCORNERS WELLNESS CENTER, LTD",
"organizational_subpart": "NO",
"enumeration_date": "2024-03-15",
"last_updated": "2024-03-15",
"certification_date": "2024-03-15",
"status": "A",
"authorized_official_last_name": "POLKY",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "FOUNDER/PRESIDENT",
"authorized_official_telephone_number": "815-988-4370",
"authorized_official_credential": "LCSW"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loves Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.