Healthcare Provider Details

I. General information

NPI: 1023413572
Provider Name (Legal Business Name): CHILDREN'S HOME & AID SOCIETY OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 07/01/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 JAMES R. THOMPSON BLVD BUILDING E
EAST ST. LOUIS IL
62201-1129
US

IV. Provider business mailing address

200 W MONROE ST STE 2100
CHICAGO IL
60606-5071
US

V. Phone/Fax

Practice location:
  • Phone: 618-874-0216
  • Fax: 618-874-7340
Mailing address:
  • Phone: 312-424-0200
  • Fax: 312-424-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2B05-IPI-129
License Number StateIL

VIII. Authorized Official

Name: MIKE SHAVER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 312-424-6801