Healthcare Provider Details

I. General information

NPI: 1619301066
Provider Name (Legal Business Name): SHADES OF HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 S WESTERN AVE STE 208
CHICAGO IL
60643-2529
US

IV. Provider business mailing address

10540 S WESTERN AVE STE 208
CHICAGO IL
60643-2529
US

V. Phone/Fax

Practice location:
  • Phone: 872-400-6113
  • Fax: 866-903-0238
Mailing address:
  • Phone: 872-400-6113
  • Fax: 866-903-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number149.015481
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AKILAH BAKER
Title or Position: CEO
Credential: LCSW
Phone: 872-400-6113