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General NPI Number Information
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NPI Number | 1619301066
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Entity Type | Organization
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Legal Business Name | SHADES OF HOPE LLC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 15941 HARLEM AVE 126
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City | TINLEY PARK
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State | IL
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Zip | 60477-1609
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Country | US
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Telephone | 773-858-3106
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Fax |
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Provider Business Mailing Address
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Address Line | 15941 HARLEM AVE 126
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City | TINLEY PARK
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State | IL
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Zip | 60477-1609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AKILAH BAKER
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Credential | LCSW
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Telephone | 773-858-3106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.015481
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License Number State | IL
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