Provider Demographics
NPI:1811758402
Name:CHICAGO CHILDRENS SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:CHICAGO CHILDRENS SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL SUPPORT PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALSHILOH
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-990-9833
Mailing Address - Street 1:7645 S KINGSTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-6456
Mailing Address - Country:US
Mailing Address - Phone:773-990-9833
Mailing Address - Fax:
Practice Address - Street 1:7645 S KINGSTON AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-6456
Practice Address - Country:US
Practice Address - Phone:773-990-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child