Provider Demographics
NPI:1417198920
Name:CHILDRENS HOME AND AID SOCIETY OF ILLINOIS
Entity Type:Organization
Organization Name:CHILDRENS HOME AND AID SOCIETY OF ILLINOIS
Other - Org Name:CHILDRENS HOME AND AID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-424-6801
Mailing Address - Street 1:200 W MONROE ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-5071
Mailing Address - Country:US
Mailing Address - Phone:312-424-0200
Mailing Address - Fax:312-424-6884
Practice Address - Street 1:403 S STATE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5556
Practice Address - Country:US
Practice Address - Phone:309-834-5277
Practice Address - Fax:309-828-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL004236251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL004236Medicaid