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Organization
COVENANT ENABLING RESIDENCES OF ILLINOIS
Active
Organization
COVENANT ENABLING RESIDENCES OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE A. SMITH (ADMINISTRATIVE COORDINATOR)
(708) 687-2038
Entity
Organization
Contact information
Practice address
15841 TERRACE DR, OAK FOREST, IL 60452-2911
(708) 687-2038
(708) 687-2762
Mailing address
15841 TERRACE DR, OAK FOREST, IL 60452-2911
(708) 687-2038
(708) 687-2762
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0039149
IL
Other
Enumeration date
02/06/2008
Last updated
02/06/2008
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