Organization
ADA S. MCKINLEY COMMUNITY SERVICES, INC.
Active
Other names
Moore House
Organization subpart
No
Provider details
NPI number
Authorized official
KEN FRIES (DIR QA&C)
(312) 385-2022
Entity
Organization
Contact information
Practice address
9135 SOUTH BRANDON, CHICAGO, IL 60617-4420
(773) 731-4033
(773) 731-2376
Mailing address
1359 W WASHINGTON BLVD, CHICAGO, IL 60607-1905
(312) 385-2000
(312) 554-0292
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
0005
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030593
IDPH LICENSE
IL
Enumeration date
10/11/2012
Last updated
05/06/2025
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