Healthcare Provider Details

I. General information

NPI: 1780500488
Provider Name (Legal Business Name): THE SHILOH WAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6622 S MARQUETTE DR
CHICAGO IL
60637-3212
US

IV. Provider business mailing address

6622 S MARQUETTE DR
CHICAGO IL
60637-3212
US

V. Phone/Fax

Practice location:
  • Phone: 464-333-0787
  • Fax:
Mailing address:
  • Phone: 464-333-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: COURTENAY PALMER
Title or Position: CEO
Credential:
Phone: 464-333-0787