Provider Demographics
NPI:1265487540
Name:OUR CHILDRENS HOMESTEAD
Entity Type:Organization
Organization Name:OUR CHILDRENS HOMESTEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:GENIESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-369-0004
Mailing Address - Street 1:387 SHUMAN BLVD
Mailing Address - Street 2:SUITE 335W
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8450
Mailing Address - Country:US
Mailing Address - Phone:630-369-0004
Mailing Address - Fax:630-369-0085
Practice Address - Street 1:387 SHUMAN BLVD
Practice Address - Street 2:SUITE 335W
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8450
Practice Address - Country:US
Practice Address - Phone:630-369-0004
Practice Address - Fax:630-369-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL266994251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management