| Center For Life Enrichment, Advancement, And Recovery, Llc | |
|
1325 W 98th Ave Crown Point IN 46307-2465 | |
| (219) 789-3423 | |
| Not Available |
| Full Name | Center For Life Enrichment, Advancement, And Recovery, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1325 W 98th Ave, Crown Point, Indiana |
| Authorized Official Name and Position | Nicole B Lewis (OWNER) |
| Authorized Official Contact | 2197893423 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Life Enrichment, Advancement, And Recovery, Llc 1325 W 98th Ave Crown Point IN 46307-2465 Ph: (219) 789-3423 | Center For Life Enrichment, Advancement, And Recovery, Llc 1325 W 98th Ave Crown Point IN 46307-2465 Ph: (219) 789-3423 |
| NPI Number | 1548856842 |
|---|---|
| Provider Enumeration Date | 12/21/2020 |
| Last Update Date | 06/15/2021 |
| Certification Date | 06/15/2021 |
| Medicare PECOS PAC ID | 5890195713 |
|---|---|
| Medicare Enrollment ID | O20210615002126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548856842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shirley Story Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710594783 PECOS PAC ID: 9830599141 Enrollment ID: I20210608001867 |
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