=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811279946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COOK COUNTY ADULT PROBATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2011
-----------------------------------------------------
Last Update Date | 09/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 MAYBROOK DR SUITE 222
-----------------------------------------------------
City | MAYWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60153-2435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-674-3282
-----------------------------------------------------
Fax | 773-674-4913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 W. WASHINGTON ST SUITE 1940
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-603-0258
-----------------------------------------------------
Fax | 312-603-9992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPUTY CHIEF PROBATION OFFICER
-----------------------------------------------------
Name | MR. REGINALD STONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-674-2871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------