Provider Demographics
NPI:1235777244
Name:ASPIRE OF ILLINOIS
Entity Type:Organization
Organization Name:ASPIRE OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-236-0979
Mailing Address - Street 1:3441 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3662
Mailing Address - Country:US
Mailing Address - Phone:847-872-1700
Mailing Address - Fax:847-872-0037
Practice Address - Street 1:3441 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-3662
Practice Address - Country:US
Practice Address - Phone:847-872-1700
Practice Address - Fax:847-872-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)