Provider Demographics
NPI:1477719003
Name:INSTITUTE FOR HUMAN RESOURCES
Entity Type:Organization
Organization Name:INSTITUTE FOR HUMAN RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-844-6109
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-0768
Mailing Address - Country:US
Mailing Address - Phone:815-844-6109
Mailing Address - Fax:
Practice Address - Street 1:920 W CUSTER AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1067
Practice Address - Country:US
Practice Address - Phone:815-844-6109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-0239-0001-AMedicaid