Provider Demographics
NPI:1497188270
Name:ONE HOPE UNITED
Entity Type:Organization
Organization Name:ONE HOPE UNITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CQIR MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-245-6556
Mailing Address - Street 1:815 N LARKIN AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3440
Mailing Address - Country:US
Mailing Address - Phone:815-730-6700
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
IL37069157003253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2A00-IPI-004Medicaid