CRYSTAL LAKE MEMORY CARE, LLC (NPI# 1164795308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164795308 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE MEMORY CARE, LLC |
| Other Organization Name | AUTUMN LEAVES OF CRYSTAL LAKE |
| Practice Address |
495 Alexandra Blvd Crystal Lake IL 60014-8908 |
| Mailing Address |
545 E John Carpenter Fwy Suite 500 Irving TX 75062-3931 |
| Practice Telephone | 8154597800 |
| Practice Fax Number | 8153563066 |
| Mailing Telephone | 2148454500 |
| Mailing Fax Number | 2148454501 |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2012-02-20 |
| Authorized Official Name | MR. CHAD ANDERSON (PRESIDENT) |
| Authorized Official Telephone | 2148454500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 5102865 | IL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Autumn Leaves of Crystal Lake | Doing Business As Name - Organization |
| Street Address |
495 ALEXANDRA BLVD |
| City | CRYSTAL LAKE |
| State | IL |
| Zip Code | 60014-8908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497394720 | Lorelei Mariano | Physical Therapist | 350 E Congress Parkway Ste A, Crystal Lake, IL 60014 | 2020-01-03 |
| 1396227070 | Behavioral Services for Autism, Inc | Behavioral Analyst | 1095 Pingree Road, Suite 204, Crystal Lake, IL 60014 | 2018-08-30 |
| 1831635564 | Isis Mendoza-garnica | Counselor | 6803 Rose Ave, Crystal Lake, IL 60014 | 2017-01-19 |
| 1134664402 | Derick Dermatology, LLC | Non-Pharmacy Dispensing Site | 525 E Congress Parkway, Suite 200, Crystal Lake, IL 60014 | 2016-12-22 |
| 1306394051 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 177 W Virginia Street, Crystal Lake, IL 60014 | 2016-09-12 |
| 1124492830 | Align Spine & Orthopaedics | Durable Medical Equipment & Medical Supplies | 60 B West Terra Cotta Ave, #265, Crystal Lake, IL 60014 | 2015-11-18 |
| 1558747428 | Shabana Nawaz | Optometrist | 4777 Northwest Highway, Crystal Lake, IL 60014 | 2015-08-03 |
| 1548649205 | Daniel Okon | Social Worker | 304 Charllote Ave, Crystal Lake, IL 60014 | 2015-05-27 |
| 1154729838 | Crystal Lake Center for Chronic Pain Sc | Nurse Practitioner | 1 South Northwest Highway, Crystal Lake, IL 60014 | 2014-12-12 |
| 1558763581 | Brooke Nicole Grandt | Occupational Therapist | 394 Heisler Ct, Crystal Lake, IL 60014 | 2014-09-22 |
| Find all providers in zip 60014 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871190504 | The Manor At Jerseyville Glen, Lp | Assisted Living Facility | 904b Estates Dr, Jerseyville, IL 62052-2377 | 2020-10-06 |
| 1861008872 | Franciscan Communities, Inc. | Assisted Living Facility | 15624 Marian Dr, Homer Glen, IL 60491-6271 | 2020-09-16 |
| 1447865118 | Oakley Courts Assisted Living Community | Assisted Living Facility | 3117 W Kunkle Blvd, Freeport, IL 61032-6943 | 2020-09-10 |
| 1083233076 | Marley Oaks Assisted Living Residence | Assisted Living Facility | 12631 187th St, Mokena, IL 60448-8731 | 2020-04-10 |
| 1447884630 | Cedarhurst of Quincy Operator, LLC | Assisted Living Facility | 319 S 48th St, Quincy, IL 62305-0593 | 2020-02-26 |
| 1164055323 | Cye Sullivan Hco, LLC | Assisted Living Facility | 20 Courtyard Blvd, Sullivan, IL 61951-7001 | 2020-02-17 |
| 1255964573 | Cottages At Salem, Inc. | Assisted Living Facility | 339 S Hotze Rd, Salem, IL 62881-6858 | 2020-02-14 |
| 1841821014 | Generations At Oakton Arms, LLC | Assisted Living Facility | 1665 Oakton Pl, Des Plaines, IL 60018-6301 | 2020-01-28 |
| 1710521984 | Cottages At Carlinville, Inc | Assisted Living Facility | 18804 Rt. 4, Carlinville, IL 62626 | 2019-10-31 |
| 1275184889 | The Encore At The Twin Cities | Assisted Living Facility | 101 N Wacker Dr Ste 608, Chicago, IL 60606-1726 | 2019-09-25 |
| Find all providers with the same taxonomy | ||||
| City | CRYSTAL LAKE |
| Zip Code | 60014 |
Please comment or provide details below to improve the information on CRYSTAL LAKE MEMORY CARE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.