Provider Demographics
NPI:1407392160
Name:KHALIL FOUNDATION
Entity Type:Organization
Organization Name:KHALIL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FAHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-474-4414
Mailing Address - Street 1:999 N MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-3581
Mailing Address - Country:US
Mailing Address - Phone:630-474-4414
Mailing Address - Fax:630-230-3364
Practice Address - Street 1:7601 S KOSTNER AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1126
Practice Address - Country:US
Practice Address - Phone:855-554-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health