Healthcare Provider Details

I. General information

NPI: 1407292030
Provider Name (Legal Business Name): HUMAN RESOURCES DEVELOPMENT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E 51ST ST
CHICAGO IL
60615-3509
US

IV. Provider business mailing address

340 E 51ST ST
CHICAGO IL
60615-3509
US

V. Phone/Fax

Practice location:
  • Phone: 312-441-9009
  • Fax: 312-441-9019
Mailing address:
  • Phone: 312-441-9009
  • Fax: 312-441-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number04073
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

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