Provider Demographics
NPI:1760718183
Name:ONE HOPE UNITED
Entity Type:Organization
Organization Name:ONE HOPE UNITED
Other - Org Name:ONE HOPE UNITED NORTHERN 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 1:333 S. WABASH AVE
Mailing Address - Street 2:SUITE 2750
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4723
Mailing Address - Country:US
Mailing Address - Phone:847-949-5631
Mailing Address - Fax:
Practice Address - Street 1:1901 N LEWIS AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-4723
Practice Address - Country:US
Practice Address - Phone:847-662-0945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL37069157003253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2A00-IPI-004Medicaid