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General NPI Number Information
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NPI Number | 1316780489
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Entity Type | Organization
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Legal Business Name | ONE HOPE UNITED - NORTHERN REGION
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 215 N MILWAUKEE AVE
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City | LAKE VILLA
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State | IL
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Zip | 60046-8529
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Country | US
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Telephone | 847-245-6500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1128
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City | LAKE VILLA
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State | IL
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Zip | 60046-1128
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Country | US
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Telephone | 847-245-6500
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Fax |
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Authorized Official
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Title or Position | ASST DIRECTOR OF BH
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Name | HEATHER CHRISTINE KELLY
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Credential |
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Telephone | 217-347-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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