Healthcare Provider Details

I. General information

NPI: 1134050164
Provider Name (Legal Business Name): PURPLE HAVEN GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 159TH STREET BLDG D UNIT 1W
OAK FOREST IL
60452
US

IV. Provider business mailing address

6006 159TH STREET BLDG D UNIT 1W
OAK FOREST IL
60452
US

V. Phone/Fax

Practice location:
  • Phone: 708-880-9055
  • Fax: 708-575-0077
Mailing address:
  • Phone: 708-880-9055
  • Fax: 708-575-0077

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 State

VIII. Authorized Official

Name: CHIDINMA OJI
Title or Position: EXECUTIVE DIRECTOR
Credential: DNP
Phone: 708-880-9055