Provider Demographics
NPI:1003391749
Name:KIDS ABOVE ALL ILLINOIS
Entity Type:Organization
Organization Name:KIDS ABOVE ALL ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAUREANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-284-0430
Mailing Address - Street 1:8765 W HIGGINS RD STE 450
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2794
Mailing Address - Country:US
Mailing Address - Phone:773-693-0300
Mailing Address - Fax:773-693-0322
Practice Address - Street 1:UNITED METHODIST CHURCH
Practice Address - Street 2:651 LILLIE STREET
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120
Practice Address - Country:US
Practice Address - Phone:630-883-8560
Practice Address - Fax:630-883-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center