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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