| Interlude Wellness Pllc | |
|
1125 Franklin St Downers Grove IL 60515-3551 | |
| (630) 247-1978 | |
| Not Available |
| Full Name | Interlude Wellness Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1125 Franklin St, Downers Grove, Illinois |
| Authorized Official Name and Position | Cornelius Francis Gorman (CLINICAL DIRECTOR & THERAPIST) |
| Authorized Official Contact | 6302471978 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Interlude Wellness Pllc 1125 Franklin St Downers Grove IL 60515-3551 Ph: (630) 247-1978 | Interlude Wellness Pllc 1125 Franklin St Downers Grove IL 60515-3551 Ph: (630) 247-1978 |
| NPI Number | 1285207571 |
|---|---|
| Provider Enumeration Date | 07/23/2021 |
| Last Update Date | 01/10/2025 |
| Certification Date | 01/10/2025 |
| Medicare PECOS PAC ID | 9537565007 |
|---|---|
| Medicare Enrollment ID | O20210908002944 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285207571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Cornelius F Gorman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669723284 PECOS PAC ID: 0648519280 Enrollment ID: I20190226003497 |
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