State of Illinois Department of Human Services

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

0971 Issued in IL

Legal business name

STATE OF ILLINOIS DEPARTMENT OF HUMAN SERVICES

Practice address

10724 S Indiana Ave
Chicago, IL 60628-3615

Phone

(312) 513-4566

NPI assigned

Oct 24, 2016

Organization subpart

No

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

Authorized official

Name

Natasha Craig

Title

Cna / Home Health Aid

Phone

(312) 513-4566

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477267200000",
    "number": "1962954099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10724 S INDIANA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606283615",
            "telephone_number": "312-513-4566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10724 S INDIANA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606283615",
            "telephone_number": "312-513-4566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ILLINOIS DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2016-10-24",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "NATASHA",
        "authorized_official_title_or_position": "CNA / HOME HEALTH AID",
        "authorized_official_telephone_number": "312-513-4566"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "IL",
            "license": "0971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrzej Staszkiewicz, MD
• Greg Staszko, PSY.D., LPHA
• Kaleoulokawai Staszkow, M.D.
• Stat Surgical Assist
• State of Illinois
• State of Mind Mental Health & Consultation Services P.C.
• Statewide Healthcare Services, Inc
• Statewide Healthcare Services, LLC
• Keitt Stathem
• Sydney Stathes, PMHNP-BC

• Adult Care Home Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Adult Care Home Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; 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.