NPIMap

Organization Active NPI

One Hope United- Northern Region

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Lake Villa, IL
National Provider Identifier
1356698476
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
004019-12 Issued in IL
Legal business name
ONE HOPE UNITED- NORTHERN REGION
Practice address
215 N Milwaukee Ave
Campus Building #5
Lake Villa, IL 60046-8529
Phone
(847) 245-6500
Fax
(847) 356-7842
NPI assigned
Aug 8, 2012
Last updated
Aug 16, 2024By the provider in NPPES
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 KellyNPI 1801384284
Title
Asst Director of BH
Phone
(217) 347-5880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 004019-12 IL Primary

Addresses

Primary practice location

215 N Milwaukee Ave
Campus Building #5
Lake Villa, IL 60046-8529

Mailing address

215 N Milwaukee Ave
P.O.Box 1128
Lake Villa, IL 60046-8529
Phone (847) 245-6500

Other identifiers 1

IdentifierTypeStateIssuer
2A00IPI004MedicaidIL

Other names 1

  • Campus Building #5 Other name

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

Locations

215 N Milwaukee Ave
Bldg 5
Lake Villa, IL 60046
Phone (847) 245-6500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1356698476",
    "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": "847-245-6500",
            "fax_number": "847-356-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N MILWAUKEE AVE",
            "address_2": "CAMPUS BUILDING #5",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600468529",
            "telephone_number": "847-245-6500",
            "fax_number": "847-356-7842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE HOPE UNITED- NORTHERN REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-08",
        "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": "ASST 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": "004019-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2A00IPI004",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campus Building #5",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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.