Provider Demographics
NPI:1962204198
Name:NEW ERA CILA
Entity type:Organization
Organization Name:NEW ERA CILA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:OSAREMEN
Authorized Official - Last Name:DAGHOLOR
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:312-671-0012
Mailing Address - Street 1:21823 CLYDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-4922
Mailing Address - Country:US
Mailing Address - Phone:312-671-0012
Mailing Address - Fax:
Practice Address - Street 1:18942 SHARON CT
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3619
Practice Address - Country:US
Practice Address - Phone:312-671-0012
Practice Address - Fax:312-671-0012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ERA CILA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities