KATRINA LAKE MD LLC (NPI# 1013536663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013536663 |
| Entity Type | Organization |
| Organization Name | KATRINA LAKE MD LLC |
| Other Organization Name | LIVE. LOVE. WELLNESS MD |
| Practice Address |
18503 Bellamy Rd Country Club Hills IL 60478-5279 |
| Practice Telephone | 7083658343 |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2020-05-01 |
| Authorized Official Name | KATRINA LAKE (OWNER) |
| Authorized Official Telephone | 7083088974 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036141229 | 05 |
| Other Name | Type Code |
|---|---|
| Live. Love. Wellness MD | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4053 183rd St Unit 2326, Country Club Hills, IL 604783413 | 7083658343 |
| Street Address |
18503 BELLAMY RD |
| City | COUNTRY CLUB HILLS |
| State | IL |
| Zip Code | 60478-5279 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285266296 | Infinity Love Care LLC | Hospice Care, Community Based | 1153 Williamsburg Road, Country Club Hills, IL 60478 | 2020-02-07 |
| 1467911313 | Atlas & Associates, Inc | Durable Medical Equipment & Medical Supplies | 4907 Sunset Lane, Country Club Hills, IL 60478 | 2019-03-19 |
| 1780196022 | Katrina Crosby | Non-emergency Medical Transport (VAN) | 18261 Ravisloe Terrace, Country Club Hills, IL 60478 | 2017-10-26 |
| 1063949675 | Rashunda Lee | Nurse Practitioner | 17469 Park Lane, Country Club Hills, IL 60478 | 2017-05-12 |
| 1558809947 | Jaylin Omauri Banks | Specialist/Technologist | 17791 Princeton Lane, Country Club Hills, IL 60478 | 2017-02-06 |
| 1083072276 | Lynn Banks | Occupational Therapy Assistant | 17800 Rosewood Terrace, Country Club Hills, IL 60478 | 2016-02-03 |
| 1215323019 | Norm Brown | Case Management | 19432 Elm Dr, Country Club Hills, IL 60478 | 2015-04-09 |
| 1265841746 | Glorinda Conley Henry | Health Educator | 4131 W. 192nd Pl., Country Club Hills, IL 60478 | 2014-08-08 |
| 1447663398 | Lillian Moore | Nurse Practitioner | 4724 West 175th Place, Country Club Hills, IL 60478 | 2014-06-09 |
| 1578999348 | Ihuoma C Ozoh | Pharmacist | 18331 Mulberry Terrace, Country Club Hills, IL 60478 | 2013-09-24 |
| Find all providers in zip 60478 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | COUNTRY CLUB HILLS |
| Zip Code | 60478 |
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| 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.