Provider Demographics
NPI:1588977839
Name:SOS CHILDREN'S VILLAGES OF ILLINOIS
Entity type:Organization
Organization Name:SOS CHILDREN'S VILLAGES OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR QI
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-388-0248
Mailing Address - Street 1:216 W JACKSON BLVD
Mailing Address - Street 2:SUITE 925
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6909
Mailing Address - Country:US
Mailing Address - Phone:312-372-8200
Mailing Address - Fax:
Practice Address - Street 1:17549 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-7634
Practice Address - Country:US
Practice Address - Phone:815-740-7280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198705253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency