Healthcare Provider Details

I. General information

NPI: 1407198013
Provider Name (Legal Business Name): HUMAN RESOURCES DEVELOPMENT INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 06/23/2021
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 79TH ST
CHICAGO IL
60620-3029
US

IV. Provider business mailing address

222 S JEFFERSON ST
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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number04073
License Number StateIL

VIII. Authorized Official

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