Provider Demographics
NPI:1316780489
Name:ONE HOPE UNITED - NORTHERN REGION
Entity type:Organization
Organization Name:ONE HOPE UNITED - NORTHERN REGION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST DIRECTOR OF BH
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:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-1128
Mailing Address - Country:US
Mailing Address - Phone:847-245-6500
Mailing Address - Fax:
Practice Address - Street 1:215 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8529
Practice Address - Country:US
Practice Address - Phone:847-245-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children