1669642815 NPI number — COOK COUNTY ADULT PROBATION

Table of content: (NPI 1669642815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669642815 NPI number — COOK COUNTY ADULT PROBATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOK COUNTY ADULT PROBATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MENTAL HEALTH UNIT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669642815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 W WASHINGTON ST STE 1940
Provider Second Line Business Mailing Address:
COOK COUNTY ADMINISTRATION BUILDING
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60602-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-603-0258
Provider Business Mailing Address Fax Number:
312-603-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 S CALIFORNIA AVE LOWR LEVEL
Provider Second Line Business Practice Location Address:
MENTAL HEALTH UNIT
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-5146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-869-3333
Provider Business Practice Location Address Fax Number:
773-869-4380
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NERO
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY CHIEF
Authorized Official Telephone Number:
773-869-3333

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04038 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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