Healthcare Provider Details

I. General information

NPI: 1265767214
Provider Name (Legal Business Name): ONE HOPE UNITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S ERNIE KRUEGER CIR
WAUKEGAN IL
60087-4156
US

IV. Provider business mailing address

333 S. WABASH AVE SUITE 2750
CHICAGO IL
60604-4156
US

V. Phone/Fax

Practice location:
  • Phone: 847-245-6800
  • Fax:
Mailing address:
  • Phone: 312-949-5631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number370697157003
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ELIZABETH HOPKINS
Title or Position: CQIR MEDICAID COORDINATOR
Credential:
Phone: 847-245-6556