# ARDEN SHORE CHILD AND FAMILY SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waukegan Group Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528319969
- **Authorized official:** DR. DORA MAYA PHD (PRESIDENT/CEO)
- **Authorized official phone:** (847) 623-1730

## Contact information

- **Practice address:** 3100 CORNELL RD, WAUKEGAN, IL 60087-2247
- **Practice address phone:** (847) 263-1858
- **Practice address fax:** (847) 263-4190
- **Mailing address:** 3100 CORNELL RD, WAUKEGAN, IL 60087-2247
- **Mailing address phone:** (847) 263-1858
- **Mailing address fax:** (847) 263-4190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 31414206 | IL | Yes |

## Other

- **Enumeration date:** 09/25/2012
- **Last updated:** 09/25/2012