NPIMap

Organization Active NPI

Life Care Wellness, Inc.

  • Professional Counselor
  • Glen Ellyn, IL
National Provider Identifier
1952767733
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180008781 Issued in IL
Legal business name
LIFE CARE WELLNESS, INC.
Practice address
800 Roosevelt Rd Ste C206
Glen Ellyn, IL 60137-5851
Phone
(630) 423-5935
Fax
(630) 545-3630
NPI assigned
Jan 8, 2016
Last updated
Feb 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Authorized official

Name
Ms. Rhonda K Kelloway, LCSW, SEPNPI 1033257332
Title
President
Phone
(630) 569-0822

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 12

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Counselor 101Y00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X
Professional Counselor 101YP2500X
Professional Counselor 101YP2500X 180008781 IL Primary
Social Worker 104100000X
Clinical Social Worker 1041C0700X
Marriage & Family Therapist 106H00000X
Pharmacist 183500000X
Pharmacotherapy Pharmacist 1835P1200X
Psychiatric Pharmacist 1835P1300X

Addresses

Primary practice location

800 Roosevelt Rd Ste C206
Glen Ellyn, IL 60137-5851

Mailing address

800 Roosevelt Rd Ste C206
Glen Ellyn, IL 60137-5851
Phone (630) 423-5935

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160503001964 IL Part B Supplier - Clinic/Group Practice 2860791449 Receives reassigned benefits from 20 practitioners
Practice locations: Chicago, IL; Glen Ellyn, IL; Sycamore, IL

National Provider Directory

National Provider Directory

Locations

1205 DeKalb Ave
Sycamore, IL 60178
Phone (630) 423-5935

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1952767733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ROOSEVELT RD STE C206",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375851",
            "telephone_number": "630-423-5935",
            "fax_number": "630-545-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ROOSEVELT RD STE C206",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375851",
            "telephone_number": "630-423-5935",
            "fax_number": "630-545-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CARE WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-08",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "KELLOWAY",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-569-0822",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW, SEP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180008781",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P1300X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Psychiatric",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.

Verify at the official NPI Registry.