NPIMap

Organization Active NPI

Illinois Children & Family Development Center LLC

  • Community/Behavioral Health Agency
  • Chicago, IL
National Provider Identifier
1013590793
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ILLINOIS CHILDREN & FAMILY DEVELOPMENT CENTER LLC
Practice address
47 W Polk St Ste 100-240
Chicago, IL 60605-2000
Phone
(708) 971-0966
NPI assigned
Apr 30, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
Timeica BethelNPI 1902411069
Title
Chief Executive Officer
Phone
(708) 971-0966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Developmentally Disabled Services Day Training Agency 251C00000X
Community/Behavioral Health Agency 251S00000X Primary
Early Intervention Provider Agency 252Y00000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X

Addresses

Primary practice location

47 W Polk St Ste 100-240
Chicago, IL 60605-2000

Mailing address

47 W Polk St Ste 100-240
Chicago, IL 60605-2000

National Provider Directory

National Provider Directory

Locations

47 W Polk St
Ste 100240
Chicago, IL 60605
Phone (708) 971-0966

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1619740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1013590793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 W POLK ST STE 100-240",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 W POLK ST STE 100-240",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052000",
            "telephone_number": "708-971-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS CHILDREN & FAMILY DEVELOPMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-30",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "BETHEL",
        "authorized_official_first_name": "TIMEICA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "708-971-0966"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; 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.