Provider Demographics
NPI:1063748127
Name:ONE HOPE UNITED
Entity type:Organization
Organization Name:ONE HOPE UNITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST DIRECTOR OF BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-347-5880
Mailing Address - Street 1:1750 E MAIN ST
Mailing Address - Street 2:SUITE 40
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2363
Mailing Address - Country:US
Mailing Address - Phone:630-513-6277
Mailing Address - Fax:
Practice Address - Street 1:1750 E MAIN ST
Practice Address - Street 2:SUITE 40
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2363
Practice Address - Country:US
Practice Address - Phone:630-513-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL37069157003253J00000X
251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2A00-IPI-004Medicaid