Provider Demographics
NPI:1871329938
Name:911 WELLNESS GROUP, LLC.
Entity type:Organization
Organization Name:911 WELLNESS GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAGRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-550-4520
Mailing Address - Street 1:765 ELA RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-6306
Mailing Address - Country:US
Mailing Address - Phone:847-550-4520
Mailing Address - Fax:
Practice Address - Street 1:765 ELA RD STE 300
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-6306
Practice Address - Country:US
Practice Address - Phone:847-550-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)