NPIMap

Organization Active NPI

Kids Hope United Northern Region

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Lake Villa, IL
National Provider Identifier
1104889633
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
004019-10 Issued in IL
Legal business name
KIDS HOPE UNITED NORTHERN REGION
Practice address
215 N Milwaukee Ave
Lake Villa, IL 60046-8529
Phone
(847) 245-6584
Fax
(847) 356-1842
NPI assigned
Apr 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Heather Christine Kelly
Title
Assistant Director of BH
Phone
(217) 347-5880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 004019-10 IL Primary

Addresses

Primary practice location

215 N Milwaukee Ave
Lake Villa, IL 60046-8529

Mailing address

215 N Milwaukee Ave
P.O. Box 1128
Lake Villa, IL 60046-8529
Phone (847) 245-6584

Other identifiers 1

IdentifierTypeStateIssuer
370697157003MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
One Hope United28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1104889633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N MILWAUKEE AVE",
            "address_2": "P.O. BOX 1128",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600468529",
            "telephone_number": "847-245-6584",
            "fax_number": "847-356-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N MILWAUKEE AVE",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600468529",
            "telephone_number": "847-245-6584",
            "fax_number": "847-356-1842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS HOPE UNITED NORTHERN REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR OF BH",
        "authorized_official_telephone_number": "217-347-5880"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "IL",
            "license": "004019-10",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370697157003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Villa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.