Organization
KIDS HOPE UNITED NORTHERN REGION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER CHRISTINE KELLY (ASSISTANT DIRECTOR OF BH)
(217) 347-5880
Entity
Organization
Contact information
Practice address
215 N MILWAUKEE AVE, LAKE VILLA, IL 60046-8529
(847) 245-6584
(847) 356-1842
Mailing address
215 N MILWAUKEE AVE, P.O. BOX 1128, LAKE VILLA, IL 60046-8529
(847) 245-6584
(847) 356-1842
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
004019-10
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370697157003
—
IL
Enumeration date
04/07/2006
Last updated
08/16/2024
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