NPIMap

Organization Active NPI

Arden Shore Child and Family Services

  • Community/Behavioral Health Agency
  • Waukegan, IL
National Provider Identifier
1013294271
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ARDEN SHORE CHILD AND FAMILY SERVICES
Practice address
329 N Genesee St
Waukegan, IL 60085-4205
Phone
(847) 623-1730
Fax
(847) 623-1733
NPI assigned
Nov 15, 2011
Last updated
Nov 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dora Maya, PHD
Title
Ceo/ President
Phone
(847) 623-1730

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary
Foster Care Agency 253J00000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 31414206 IL

Addresses

Primary practice location

329 N Genesee St
Waukegan, IL 60085-4205

Mailing address

329 N Genesee St
Waukegan, IL 60085-4205
Phone (847) 623-1730

National Provider Directory

National Provider Directory
Tax ID family
Arden Shore Child and Family Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

329 N Genesee St
Waukegan, IL 60085
Phone (847) 623-1730

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1013294271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 N GENESEE ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600854205",
            "telephone_number": "847-623-1730",
            "fax_number": "847-623-1733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 N GENESEE ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600854205",
            "telephone_number": "847-623-1730",
            "fax_number": "847-623-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARDEN SHORE CHILD AND FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-15",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "MAYA",
        "authorized_official_first_name": "DORA",
        "authorized_official_title_or_position": "CEO/ PRESIDENT",
        "authorized_official_telephone_number": "847-623-1730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "IL",
            "license": "31414206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.