NPIMap

Organization Active NPI

Arden Shore Child and Family Services

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Waukegan, IL
National Provider Identifier
1528319969
Registry record updated Sep 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
31414206 Issued in IL
Legal business name
ARDEN SHORE CHILD AND FAMILY SERVICES
Practice address
3100 Cornell Rd
Waukegan, IL 60087-2247
Phone
(847) 263-1858
Fax
(847) 263-4190
NPI assigned
Sep 25, 2012
Last updated
Sep 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2012

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

Authorized official

Name
Dr. Dora Maya, PHD
Title
President/Ceo
Phone
(847) 623-1730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 31414206 IL Primary

Addresses

Primary practice location

3100 Cornell Rd
Waukegan, IL 60087-2247

Mailing address

3100 Cornell Rd
Waukegan, IL 60087-2247
Phone (847) 263-1858

Other names 1

  • Waukegan Group Home Other name

National Provider Directory

National Provider Directory
Tax ID family
Arden Shore Child and Family Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348531200000",
    "number": "1528319969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 CORNELL RD",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600872247",
            "telephone_number": "847-263-1858",
            "fax_number": "847-263-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 CORNELL RD",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600872247",
            "telephone_number": "847-263-1858",
            "fax_number": "847-263-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARDEN SHORE CHILD AND FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-25",
        "last_updated": "2012-09-25",
        "status": "A",
        "authorized_official_last_name": "MAYA",
        "authorized_official_first_name": "DORA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "847-623-1730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "IL",
            "license": "31414206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waukegan Group Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waukegan, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; 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.