Healthcare Provider Details

I. General information

NPI: 1194644237
Provider Name (Legal Business Name): JELANI HELATHCARE AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 ILLINOIS ST
PARK FOREST IL
60466-1117
US

IV. Provider business mailing address

221 ILLINOIS ST
PARK FOREST IL
60466-1117
US

V. Phone/Fax

Practice location:
  • Phone: 630-864-0704
  • Fax:
Mailing address:
  • Phone: 630-864-0704
  • 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 State

VIII. Authorized Official

Name: DAMO ANTWINE-JELANI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: ED.S
Phone: 630-864-0704