Jeremiah Community Outreach Services, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

A52410001A Issued in IL

Legal business name

JEREMIAH COMMUNITY OUTREACH SERVICES, INC

Practice address

935 175TH St
Suite 302
Homewood, IL 60430-2049

Phone

(708) 914-4248

Fax

(708) 991-2975

NPI assigned

Jun 5, 2014

Last updated

Jun 5, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Shirley Ann Golladay, CADC

Title

Executive Director

Phone

(708) 914-4248

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1255744371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 175TH ST",
            "address_2": "SUITE 302",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302049",
            "telephone_number": "708-914-4248",
            "fax_number": "708-991-2975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 175TH ST",
            "address_2": "SUITE 302",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302049",
            "telephone_number": "708-914-4248",
            "fax_number": "708-991-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEREMIAH COMMUNITY OUTREACH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-05",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "GOLLADAY",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-914-4248",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CADC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "A52410001A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; 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.