Provider Demographics
NPI:1649970385
Name:VOLUNTEERS OF AMERICA OF ILLINOIS
Entity type:Organization
Organization Name:VOLUNTEERS OF AMERICA OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:312-810-4340
Mailing Address - Street 1:1919 MAIN ST
Mailing Address - Street 2:HOPE HALL
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:312-810-4340
Mailing Address - Fax:708-731-3185
Practice Address - Street 1:1919 MAIN ST
Practice Address - Street 2:HOPE HALL
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:312-810-4340
Practice Address - Fax:708-731-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty