Provider Demographics
NPI:1194532879
Name:THIS IS THE LIFE FOR ME LLC
Entity type:Organization
Organization Name:THIS IS THE LIFE FOR ME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OUEDRAOGO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-593-0920
Mailing Address - Street 1:5000 W RIBBON DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449
Mailing Address - Country:US
Mailing Address - Phone:773-593-0920
Mailing Address - Fax:
Practice Address - Street 1:5000 W RIBBON DRIVE
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449
Practice Address - Country:US
Practice Address - Phone:773-593-0920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty