Healthcare Provider Details

I. General information

NPI: 1962738021
Provider Name (Legal Business Name): ONE HOPE UNITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MILWAUKEE AVE
LAKE VILLA IL
60046-8529
US

IV. Provider business mailing address

333 S. WABASH AVE SUITE 2750
CHICAGO IL
60604-8529
US

V. Phone/Fax

Practice location:
  • Phone: 847-245-6500
  • Fax:
Mailing address:
  • Phone: 312-949-5631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number37069157003
License Number StateIL

VIII. Authorized Official

Name: HEATHER CHRISTINE KELLY
Title or Position: ASST DIRECTOR OF BH
Credential:
Phone: 217-347-5880