Covenant Enabling Residences of Illinois

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

0039149 Issued in IL

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

Feb 6, 2008

Last updated

Feb 6, 2008By 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

Mrs. Julie A. Smith

Title

Administrative Coordinator

Phone

(708) 687-2038

Specialties & licenses 1

Addresses

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

  dba Bjorklund House

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Oak Forest, IL
  • NPI 1285188342
  NPD tax ID

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1659559292",
    "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": "2008-02-06",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATIVE COORDINATOR",
        "authorized_official_telephone_number": "708-687-2038",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0039149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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 (Bjorklund House)
• Cory Cunningham, PA-C
• Colleen Curran, M.S.
• Kelsey M Dagenais, LCPC
• Lauren Elizabeth Danzie, RN
• Nivedita J Dave, MD

• Intellectual Disabilities Intermediate Care Facility in Oak Forest, IL
• Providers in Oak Forest, IL by specialty
• Intellectual Disabilities Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; 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.