Provider Demographics
NPI:1609045624
Name:HEALTH DISABILITY AGING RESOURCE ADVOCATES
Entity Type:Organization
Organization Name:HEALTH DISABILITY AGING RESOURCE ADVOCATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-332-9559
Mailing Address - Street 1:4 E OGDEN AVE # 344
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3506
Mailing Address - Country:US
Mailing Address - Phone:708-332-9559
Mailing Address - Fax:708-332-9559
Practice Address - Street 1:4 E OGDEN AVE # 344
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-3506
Practice Address - Country:US
Practice Address - Phone:708-332-9559
Practice Address - Fax:708-332-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-24
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
IL1609045624251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management