Provider Demographics
NPI:1528534989
Name:JEWISH CHILD AND FAMILY SERVICES
Entity Type:Organization
Organization Name:JEWISH CHILD AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-467-3758
Mailing Address - Street 1:216 W JACKSON BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9004 POTTAWATTAMI DR
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1910
Practice Address - Country:US
Practice Address - Phone:773-765-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH CHILD AND FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid