Provider Demographics
NPI:1295012193
Name:CRISIS INTERVENTION THROUGH CHRIST
Entity Type:Organization
Organization Name:CRISIS INTERVENTION THROUGH CHRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-242-2971
Mailing Address - Street 1:9964 S WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1326
Mailing Address - Country:US
Mailing Address - Phone:888-242-2971
Mailing Address - Fax:888-242-2971
Practice Address - Street 1:9964 S WINSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1326
Practice Address - Country:US
Practice Address - Phone:888-242-2971
Practice Address - Fax:888-242-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health