Provider Demographics
NPI:1679344048
Name:HARMONY FALLS CRYSTAL LAKE LLC
Entity type:Organization
Organization Name:HARMONY FALLS CRYSTAL LAKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KOCOL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:262-203-0646
Mailing Address - Street 1:757 S MCHENRY AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7443
Mailing Address - Country:US
Mailing Address - Phone:262-203-0646
Mailing Address - Fax:
Practice Address - Street 1:757 S MCHENRY AVE STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7443
Practice Address - Country:US
Practice Address - Phone:262-203-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty