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

Practice address

15841 Terrace Dr
Oak Forest, IL 60452-2911

Phone

(708) 687-2038

Fax

(708) 687-2762

NPI assigned

Aug 6, 2016

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

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
• Cook County
• Cook County
• Core Family Home Health Inc
• Mackenzie Coulter, CCC-SLP
• Covenant Enabling Residences of Illinois
• Cory Cunningham, PA-C
• Colleen Curran, M.S.
• Kelsey M Dagenais, LCPC
• Lauren Elizabeth Danzie, RN

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.