Healthcare Provider Details

I. General information

NPI: 1083723027
Provider Name (Legal Business Name): KIDS ABOVE ALL ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 W. HIGGINS SUITE 450
CHICAGO IL
60631
US

IV. Provider business mailing address

8765 W. HIGGINS ROAD SUITE 450
CHICAGO IL
60631
US

V. Phone/Fax

Practice location:
  • Phone: 773-693-0300
  • Fax: 773-693-0322
Mailing address:
  • Phone: 773-693-0300
  • Fax: 773-693-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number012033-10
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number012033-10
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. JERI L LAUREANO
Title or Position: CHIEF OPERATING OFFICER
Credential: LCSW
Phone: 773-239-8940