Provider Demographics
NPI:1316268352
Name:ONE HOPE UNITED
Entity type:Organization
Organization Name:ONE HOPE UNITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CQIR MEDICAID COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-245-6556
Mailing Address - Street 1:333 S. WABASH AVE
Mailing Address - Street 2:SUITE 2750
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-2036
Mailing Address - Country:US
Mailing Address - Phone:312-949-5631
Mailing Address - Fax:217-345-4611
Practice Address - Street 1:701 MONROE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2036
Practice Address - Country:US
Practice Address - Phone:217-345-6554
Practice Address - Fax:217-345-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
IL01005311253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2A00IPI004Medicaid