=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669642815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COOK COUNTY ADULT PROBATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2008
-----------------------------------------------------
Last Update Date | 03/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2650 S CALIFORNIA AVE LOWR LEVEL MENTAL HEALTH UNIT
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60608-5146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-869-3333
-----------------------------------------------------
Fax | 773-869-4380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 W WASHINGTON ST STE 1940 COOK COUNTY ADMINISTRATION BUILDING
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-603-0258
-----------------------------------------------------
Fax | 312-603-9992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPUTY CHIEF
-----------------------------------------------------
Name | MS. REGINA NERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-869-3333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------