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AUTUMN LEAVES OF CRYSTAL LAKE
NPI 1164795308
Assisted Living Facility in Crystal Lake, IL

Active since February 20, 2012
495 ALEXANDRA BLVD, CRYSTAL LAKE, IL 60014(815) 459-7800(815) 356-3066 Get Directions Write a Review

NPPES record last updated: February 20, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Autumn Leaves Of Crystal Lake NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AUTUMN LEAVES OF CRYSTAL LAKE (NPI 1164795308) is a healthcare organization registered as an assisted living facility in Crystal Lake, Illinois and active in the NPI registry since February 2012. The organization lists Chad Anderson, President, as its authorized official.

NPPES Registry Identity

NPI1164795308
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameCRYSTAL LAKE MEMORY CARE, LLC
Location Address495 ALEXANDRA BLVDCrystal Lake, IL 60014-8908
Mailing Address545 E John Carpenter Fwy, Suite 500Irving, TX 75062-3931 · (214) 845-4500 · Fax (214) 845-4501
Phone(815) 459-7800
Fax(815) 356-3066
Organization SubpartNo
Authorized OfficialChad AndersonPresident · (214) 845-4500
Enumeration DateFebruary 20, 2012
✔ NPI 1164795308 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in IL · 5102865
Definition
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.
495 ALEXANDRA BLVD, Crystal Lake, IL 60014
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Other Names 1

Doing Business AsAutumn Leaves Of Crystal Lake

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Crystal Lake Memory Care, LLC's NPI number?

The NPI number for Crystal Lake Memory Care, LLC is 1164795308. It was assigned to this organization in the NPPES registry on February 20, 2012. The provider is doing business as Autumn Leaves Of Crystal Lake.

Where is Crystal Lake Memory Care, LLC located?

Crystal Lake Memory Care, LLC is located at 495 Alexandra Blvd, Crystal Lake, IL 60014. The listed phone number is (815) 459-7800.

What is Crystal Lake Memory Care, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Crystal Lake Memory Care, LLC was last updated on February 20, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.