Healthcare Provider Details

I. General information

NPI: 1003238106
Provider Name (Legal Business Name): CHILDREN'S HOME AND AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LOU ANN DR
HERRIN IL
62948-3733
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 618-988-1330
  • Fax:
Mailing address:
  • Phone: 312-424-0200
  • Fax: 312-424-6884

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 State

VIII. Authorized Official

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