Organization
ILLINOIS CHILDREN & FAMILY DEVELOPMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMEICA BETHEL (CHIEF EXECUTIVE OFFICER)
(708) 971-0966
Entity
Organization
Contact information
Practice address
47 W POLK ST STE 100-240, CHICAGO, IL 60605-2000
(708) 971-0966
Mailing address
47 W POLK ST STE 100-240, CHICAGO, IL 60605-2000
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
04/30/2021
Last updated
04/30/2021
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