Healthcare Provider Details

I. General information

NPI: 1407212004
Provider Name (Legal Business Name): ESPERANZA COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N MARSHFIELD AVE
CHICAGO IL
60622-6731
US

IV. Provider business mailing address

520 N MARSHFIELD AVE
CHICAGO IL
60622-6731
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-6097
  • Fax: 312-243-2076
Mailing address:
  • Phone: 312-243-6097
  • Fax: 312-243-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number11519395
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JAYNE M DREW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 312-243-6097