Healthcare Provider Details

I. General information

NPI: 1639348253
Provider Name (Legal Business Name): HUMAN RESOURCES DEVELOPMENT INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E 114TH ST
CHICAGO IL
60628-4921
US

IV. Provider business mailing address

222 S JEFFERSON ST 200
CHICAGO IL
60661-5603
US

V. Phone/Fax

Practice location:
  • Phone: 773-660-4630
  • Fax: 773-660-4650
Mailing address:
  • Phone: 312-441-9009
  • Fax: 312-441-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number04073
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. RENZY RICHARDSON
Title or Position: DIRECTOR OF CONTRACT ADMINISTRATION
Credential:
Phone: 312-441-9009