Provider Demographics
NPI:1154906998
Name:MINDFUL LIVING CENTER - CHICAGO LLC
Entity type:Organization
Organization Name:MINDFUL LIVING CENTER - CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLONEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-419-3869
Mailing Address - Street 1:900 PACIFIC COAST HWY APT 105
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-4859
Mailing Address - Country:US
Mailing Address - Phone:323-419-3869
Mailing Address - Fax:
Practice Address - Street 1:5061 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2706
Practice Address - Country:US
Practice Address - Phone:323-419-3869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health