Provider Demographics
NPI:1295303006
Name:FOSTERING HOPE OF ILLINOIS
Entity type:Organization
Organization Name:FOSTERING HOPE OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDIENT
Authorized Official - Prefix:
Authorized Official - First Name:JERROD
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-276-3937
Mailing Address - Street 1:1706 PRAIRIE WIND DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-0686
Mailing Address - Country:US
Mailing Address - Phone:872-276-3937
Mailing Address - Fax:
Practice Address - Street 1:1706 PRAIRIE WIND DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-0686
Practice Address - Country:US
Practice Address - Phone:872-276-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care