Hazel Bland Promise Center

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

199200170S Issued in IL

Legal business name

HAZEL BLAND PROMISE CENTER

Practice address

2900 State St
East Saint Louis, IL 62205-2234

Phone

(618) 274-3500

NPI assigned

Jun 28, 2016

Organization subpart

No

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

Authorized official

Name

Ms. Vivian E. Thompson

Title

Family Support Unit Director

Phone

(618) 274-3500

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1235580564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622052234",
            "telephone_number": "618-274-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622052234",
            "telephone_number": "618-274-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL BLAND PROMISE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-28",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "FAMILY SUPPORT UNIT DIRECTOR",
        "authorized_official_telephone_number": "618-274-3500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "199200170S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Dean Harper, RPH
• Erica Harvey
• Mohammad Hashemi, MD
• Annie Mae Haynes
• Valda Haywood, LCSW
• Carrie Linda Hegdahl, NCSP
• Alissa Anne Helm, DO
• Harry George Henderson, DDS
• Yolanda L Hoag, ACNPC-AG
• Marilyn Holmes, MA, LPC, ATR-P

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; 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.