Provider Demographics
NPI:1295015691
Name:ONE HOPE UNITED NORTHERN REGION
Entity Type:Organization
Organization Name:ONE HOPE UNITED NORTHERN REGION
Other - Org Name:JOLIET
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-949-5500
Mailing Address - Street 1:815 N LARKIN AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3438
Mailing Address - Country:US
Mailing Address - Phone:815-730-6700
Mailing Address - Fax:815-730-7510
Practice Address - Street 1:815 N LARKIN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3438
Practice Address - Country:US
Practice Address - Phone:815-730-6700
Practice Address - Fax:815-730-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL37069157003253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency