Provider Demographics
NPI:1417128737
Name:OPTIONS & ADVOCACY FOR MCHENRY COUNTY
Entity Type:Organization
Organization Name:OPTIONS & ADVOCACY FOR MCHENRY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:815-477-4720
Mailing Address - Street 1:365 MILLENNIUM DR STE A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3747
Mailing Address - Country:US
Mailing Address - Phone:815-477-4720
Mailing Address - Fax:815-477-4700
Practice Address - Street 1:365 MILLENNIUM DR STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3747
Practice Address - Country:US
Practice Address - Phone:815-477-4720
Practice Address - Fax:815-477-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251X00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001OtherKID KARE
IL=========OtherSERVICE COORDINATION
IL=========002OtherEARLY INTERVENTION PROVID