Provider Demographics
NPI:1427405745
Name:ASD LIFE INC.
Entity type:Organization
Organization Name:ASD LIFE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-754-6314
Mailing Address - Street 1:11301 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-2001
Mailing Address - Country:US
Mailing Address - Phone:630-631-9623
Mailing Address - Fax:866-823-8780
Practice Address - Street 1:11301 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2001
Practice Address - Country:US
Practice Address - Phone:708-586-2604
Practice Address - Fax:866-823-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-15-20882251C00000X
261QM0801X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)