Provider Demographics
NPI:1649395971
Name:ASPIRE OF ILLINOIS
Entity Type:Organization
Organization Name:ASPIRE OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF BUSINESS ADMININSTATION
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-547-3550
Mailing Address - Street 1:9901 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-3709
Mailing Address - Country:US
Mailing Address - Phone:708-547-3550
Mailing Address - Fax:708-547-4067
Practice Address - Street 1:105 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-1220
Practice Address - Country:US
Practice Address - Phone:708-547-3550
Practice Address - Fax:708-547-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004OtherHEALTHCARE AND FAMILY SER