Provider Demographics
NPI:1962738021
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 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 1:333 S. WABASH AVE
Mailing Address - Street 2:SUITE 2750
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-8529
Mailing Address - Country:US
Mailing Address - Phone:312-949-5631
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:2009-10-26
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL37069157003253J00000X
320800000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No253J00000XAgenciesFoster Care Agency
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2A00-IPI-004Medicaid