Provider Demographics
NPI:1710315866
Name:OUR CHILDREN'S HOMESTEAD
Entity Type:Organization
Organization Name:OUR CHILDREN'S HOMESTEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-369-0004
Mailing Address - Street 1:7210 E STATE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2622
Mailing Address - Country:US
Mailing Address - Phone:815-316-7626
Mailing Address - Fax:
Practice Address - Street 1:7210 E STATE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2622
Practice Address - Country:US
Practice Address - Phone:815-316-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26699407253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency