Healthcare Provider Details

I. General information

NPI: 1932598893
Provider Name (Legal Business Name): ONE FAMILY ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 W 13TH ST
CHICAGO IL
60608-1881
US

IV. Provider business mailing address

216 W JACKSON BLVD STE 925
CHICAGO IL
60606-6996
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-1901
  • Fax: 312-243-3086
Mailing address:
  • Phone: 312-372-8200
  • Fax: 312-372-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number198705
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: GLORIA MARIN COCKERILL
Title or Position: DIRECTOR OF BEHAVIORAL HEALTH
Credential: LCSW
Phone: 312-243-1901