State of Illinois

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

Legal business name

STATE OF ILLINOIS

Practice address

2424W.Charleston
Chicago, IL 60647

Phone

(773) 276-8863

NPI assigned

Jul 27, 2006

Last updated

Aug 22, 2020By 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

Mr. Chris Greenwood

Title

Casemanager

Phone

(312) 666-3494

Specialties & licenses 1

Addresses

Other names 1

• erie Family Health Center Other name

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lawrence House

  dba Pharmacist

  • Exclusive Provider Organization
  • Chicago, IL
  • NPI 1558728519
  NPPES parent name

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609890235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424W.CHARLESTON",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60647",
            "telephone_number": "773-276-8863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424W.CHARLESTON",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60647",
            "telephone_number": "773-276-8863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENWOOD",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CASEMANAGER",
        "authorized_official_telephone_number": "312-666-3494",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "erie Family Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Beata Staszewski, LCPC
• Andrzej Staszkiewicz, MD
• Greg Staszko, PSY.D., LPHA
• Kaleoulokawai Staszkow, M.D.
• Stat Surgical Assist
• State of Illinois Department of Human Services
• State of Mind Mental Health & Consultation Services P.C.
• Statewide Healthcare Services, Inc (Oxford Healthcare)
• Statewide Healthcare Services, LLC (Help at Home)
• Keitt Stathem

• Physical Disabilities Residential Treatment Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Disabilities Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.