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General NPI Number Information
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NPI Number | 1417386046
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Entity Type | Organization
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Legal Business Name | OUR CHILDREN'S HOMESTEAD
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 387 SHUMAN BLVD SUITE 170E
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City | NAPERVILLE
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State | IL
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Zip | 60563-8450
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Country | US
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Telephone | 630-369-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 387 SHUMAN BLVD SUITE 170E
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City | NAPERVILLE
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State | IL
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Zip | 60563-8450
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Country | US
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Telephone | 630-369-0004
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARISSA ALLEN
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Credential |
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Telephone | 630-369-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 26699407
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License Number State | IL
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