Provider Demographics
NPI:1558324087
Name:ONE HOPE UNITED
Entity Type:Organization
Organization Name:ONE HOPE UNITED
Other - Org Name:ONE HOPE UNITED- HUDELSON REGION
Other - Org Type:Former Legal Business Name
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 1:1400 E MCCORD ST
Mailing Address - Street 2:P.O. BOX 548
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3702
Mailing Address - Country:US
Mailing Address - Phone:618-532-4311
Mailing Address - Fax:618-532-4318
Practice Address - Street 1:1400 E MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3702
Practice Address - Country:US
Practice Address - Phone:618-532-4311
Practice Address - Fax:618-532-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL010052-10322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370697157001Medicaid