Provider Demographics
NPI:1902063266
Name:HEALING INSTITUTE, LLC
Entity Type:Organization
Organization Name:HEALING INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:D'ANDRIENNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-465-9500
Mailing Address - Street 1:2416 BLOOMER DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4809
Mailing Address - Country:US
Mailing Address - Phone:618-465-9500
Mailing Address - Fax:618-465-9502
Practice Address - Street 1:2416 BLOOMER DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4809
Practice Address - Country:US
Practice Address - Phone:618-465-9500
Practice Address - Fax:618-465-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-085886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG41835Medicare UPIN