Healthcare Provider Details

I. General information

NPI: 1255251161
Provider Name (Legal Business Name): CRESCENT CILA HOMES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19729 LAKE PARK DR
LYNWOOD IL
60411-1556
US

IV. Provider business mailing address

19729 LAKE PARK DR
LYNWOOD IL
60411-1556
US

V. Phone/Fax

Practice location:
  • Phone: 708-518-3260
  • Fax:
Mailing address:
  • Phone: 708-518-3260
  • 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 StateNULL

VIII. Authorized Official

Name: BABATUNDE SHONEYE
Title or Position: AGENCY MANAGER/ADMINISTRATOR
Credential:
Phone: 773-678-3868