Provider Demographics
NPI:1871845008
Name:ADA S. MCKINLEY COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:ADA S. MCKINLEY COMMUNITY SERVICES, INC.
Other - Org Name:MOORE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF QUALITY ASSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:312-385-2031
Mailing Address - Street 1:1359 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1905
Mailing Address - Country:US
Mailing Address - Phone:312-385-2000
Mailing Address - Fax:312-554-0292
Practice Address - Street 1:9135 SOUTH BRANDON
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4420
Practice Address - Country:US
Practice Address - Phone:773-731-4033
Practice Address - Fax:773-731-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
315P00000X
IL0005320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0030593OtherIDPH LICENSE