Provider Demographics
NPI:1235684564
Name:KHALIL FOUNDATION
Entity Type:Organization
Organization Name:KHALIL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FAHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-362-0021
Mailing Address - Street 1:999 N MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-3581
Mailing Address - Country:US
Mailing Address - Phone:630-474-4414
Mailing Address - Fax:
Practice Address - Street 1:500 W CENTRAL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2347
Practice Address - Country:US
Practice Address - Phone:630-362-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health