Healthcare Provider Details

I. General information

NPI: 1497188270
Provider Name (Legal Business Name): ONE HOPE UNITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N LARKIN AVE SUITE 109
JOLIET IL
60435-3438
US

IV. Provider business mailing address

815 N LARKIN AVE STE 207
JOLIET IL
60435-3440
US

V. Phone/Fax

Practice location:
  • Phone: 815-730-6700
  • Fax:
Mailing address:
  • Phone: 815-730-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number37069157003
License Number StateIL

VIII. Authorized Official

Name: ELIZABETH HOPKINS
Title or Position: CQIR MEDICAID COORDINATOR
Credential:
Phone: 847-245-6556