Provider Demographics
NPI:1154686079
Name:KEY TO HOPE LLC
Entity Type:Organization
Organization Name:KEY TO HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLYE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WINBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-523-0728
Mailing Address - Street 1:1748 E 84TH PL
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1748 E 84TH PL
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2275
Practice Address - Country:US
Practice Address - Phone:312-523-0728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILHSD0V700Medicaid