Provider Demographics
NPI:1275682551
Name:ILLINOIS BAPTIST CHILDREN'S HOME AND FAMILY SERVICES
Entity Type:Organization
Organization Name:ILLINOIS BAPTIST CHILDREN'S HOME AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-382-4164
Mailing Address - Street 1:949 COUNTY ROAD 1300 N
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-5010
Mailing Address - Country:US
Mailing Address - Phone:618-328-4164
Mailing Address - Fax:618-382-3239
Practice Address - Street 1:949 COUNTY ROAD 1300 N
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-5010
Practice Address - Country:US
Practice Address - Phone:618-328-4164
Practice Address - Fax:618-382-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL401813251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health