Covenant Enabling Residences of Illinois

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

COVENANT ENABLING RESIDENCES OF ILLINOIS

Doing business as

Bjorklund House

Practice address

15841 Terrace Dr
Oak Forest, IL 60452-2911

Phone

(708) 687-2038

Fax

(708) 687-2762

NPI assigned

Aug 6, 2016

Last updated

Aug 6, 2016By 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

Julie Ann Smith

Title

Administrator

Phone

(708) 687-2038

Specialties & licenses 2

Addresses

Other names 1

• Bjorklund House Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285188342. Details of each certification follow.

• CCN 14G325 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G325

Legal name

BJORKLUND HOUSE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Mar 4, 1994

Last certification

Aug 2, 2024

Beds

16

Ownership / control type

Private (non-profit)

Facility address

15841 Terrace Drive
Oak Forest, IL 60452

Tax ID family

Bjorklund House2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Covenant Enabling Residences of Illinois

  • Intellectual Disabilities Intermediate Care Facility
  • Oak Forest, IL
  • NPI 1659559292
  NPD tax ID

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

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470441600000",
    "number": "1285188342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15841 TERRACE DR",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604522911",
            "telephone_number": "708-687-2038",
            "fax_number": "708-687-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15841 TERRACE DR",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604522911",
            "telephone_number": "708-687-2038",
            "fax_number": "708-687-2762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT ENABLING RESIDENCES OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-06",
        "last_updated": "2016-08-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "708-687-2038"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bjorklund House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cook County (Oak Forest Urgent/Immediate Care Clinic)
• Cook County (Oak Forest Hospital)
• Cook County (Achn Specialty Care Center -Ofh)
• Core Family Home Health Inc
• Mackenzie Coulter, CCC-SLP
• Covenant Enabling Residences of Illinois
• Claire Christine Crnich
• Cory Cunningham, PA-C
• Colleen Curran, M.S.
• Kelsey M Dagenais, LCPC

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Oak Forest, IL
• Providers in Oak Forest, IL by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.