Illinois Youth Advocate Program

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

338374-06 Issued in IL

Legal business name

ILLINOIS YOUTH ADVOCATE PROGRAM

Practice address

191 W 155TH PL
Harvey, IL 60426-3413

Phone

(708) 596-6955

Fax

(708) 596-7464

NPI assigned

Nov 6, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Edward M. Farmer, M.A.

Title

Executive Director

Phone

(708) 596-6955

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871662882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 W 155TH PL",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263413",
            "telephone_number": "708-596-6955",
            "fax_number": "708-596-7464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 W 155TH PL",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263413",
            "telephone_number": "708-596-6955",
            "fax_number": "708-596-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS YOUTH ADVOCATE PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FARMER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-596-6955",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "338374-06",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.