Healthcare Provider Details

I. General information

NPI: 1841539640
Provider Name (Legal Business Name): ONE HOPE UNITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 N WATER TOWER PL
MOUNT VERNON IL
62864-6295
US

IV. Provider business mailing address

333 S. WABASH AVE SUITE 2750
CHICAGO IL
60604-3702
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-8266
  • Fax:
Mailing address:
  • Phone: 312-949-5631
  • Fax:

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: HEATHER CHRISTINE KELLY
Title or Position: ASST. DIRECTOR OF BEHAVIORAL HEALTH
Credential:
Phone: 217-273-5398