Organization
ESSENTIAL LIFESTYLES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH DONNER (OWNER/MEMBER)
(847) 957-3157
Entity
Organization
Contact information
Practice address
7408 S HARVARD AVE, CHICAGO, IL 60621-3424
(847) 957-3157
Mailing address
7645 S SAINT LAWRENCE AVE, CHICAGO, IL 60619-2419
(773) 842-8245
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
IL
Other
Enumeration date
07/03/2018
Last updated
07/03/2018
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