Provider Demographics
NPI:1063174175
Name:WEST SUBURBAN MATERNAL WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:WEST SUBURBAN MATERNAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDERSCHIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-550-7474
Mailing Address - Street 1:29 S WEBSTER ST STE 330
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4564
Mailing Address - Country:US
Mailing Address - Phone:331-330-7378
Mailing Address - Fax:
Practice Address - Street 1:29 S WEBSTER ST STE 330
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4564
Practice Address - Country:US
Practice Address - Phone:331-330-7378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health