COVENANT ENABLING RESIDENCES OF ILLINOIS (NPI# 1659559292) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659559292 |
| Entity Type | Organization |
| Organization Name | COVENANT ENABLING RESIDENCES OF ILLINOIS |
| Practice Address |
15841 Terrace Dr Oak Forest IL 60452-2911 |
| Practice Telephone | 7086872038 |
| Practice Fax Number | 7086872762 |
| Mailing Telephone | 7086872038 |
| Mailing Fax Number | 7086872762 |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2008-02-06 |
| Authorized Official Name | MRS. JULIE A. SMITH (ADMINISTRATIVE COORDINATOR) |
| Authorized Official Telephone | 7086872038 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 0039149 | IL | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285188342 | Covenant Enabling Residences of Illinois | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15841 Terrace Dr, Oak Forest, IL 60452-2911 | 2016-08-06 |
| Street Address |
15841 TERRACE DR |
| City | OAK FOREST |
| State | IL |
| Zip Code | 60452-2911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285188342 | Covenant Enabling Residences of Illinois | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15841 Terrace Dr, Oak Forest, IL 60452-2911 | 2016-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831713098 | Oak Family Dental | Dentist | 6056 W. 159th Ave., Oak Forest, IL 60452 | 2020-06-03 |
| 1457982340 | Cook County | Family Medicine | 15900 S. Cicero, Oak Forest, IL 60452 | 2020-01-29 |
| 1265942718 | Suzanne Ankarlo | Speech-Language Pathologist | 3545 West Victoria Drive, Oak Forest, IL 60452 | 2017-10-10 |
| 1154855112 | True Laboratories LLC | Clinical Medical Laboratory | 5320 159th St Ste 505, Oak Forest, IL 60452 | 2017-04-17 |
| 1902347297 | Mena Loka Sr. | Physical Therapy Assistant | 6404 Nature Dr, Oak Forest, IL 60452 | 2017-03-20 |
| 1447797097 | Angelique Mayes-lamon | Clinic/Center | 15900 S Cicero Avenue, Building E, Oak Forest, IL 60452 | 2017-01-20 |
| 1265980759 | Surinder Sharma I | Pharmacist | 15900 So Cicero Ave, 15900 So Cicero Ave Bldg F, Oak Forest, IL 60452 | 2016-09-14 |
| 1326596800 | Gervaise Hunter-morris | Pharmacist | 15900 S. Cicero Avenue, Oak Forest, IL 60452 | 2016-09-14 |
| 1538519111 | Aunt Martha's Youth Service Center, Inc. | Clinic/Center | 15350 Oak Park Ave., Oak Forest, IL 60452 | 2016-06-15 |
| 1760836720 | Thh Acquisition LLC I | Durable Medical Equipment & Medical Supplies | 4149 166th St, Oak Forest, IL 60452 | 2016-04-15 |
| Find all providers in zip 60452 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871039669 | Mount St Joseph | Intermediate Care Facility, Mentally Retarded | 24955 N Us Highway 12, Lake Zurich, IL 60047-8919 | 2017-01-17 |
| 1447792221 | Shore Community Services, Inc. | Intermediate Care Facility, Mentally Retarded | 8350 Laramie Ave, Skokie, IL 60077-2461 | 2016-11-10 |
| 1770930968 | Community Support Systems | Intermediate Care Facility, Mentally Retarded | 2311 Veterans Drive, Effingham, IL 62401 | 2016-05-18 |
| 1265898266 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 102 S Douglas St, Mc Leansboro, IL 62859-1637 | 2016-01-06 |
| 1164888160 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 1406 W Delaware St, Fairfield, IL 62837-2336 | 2016-01-06 |
| 1376909374 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 416 Chula Vista Dr, Belleville, IL 62221-3160 | 2016-01-06 |
| 1437515434 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 206 N Washington St, Mc Leansboro, IL 62859-1049 | 2016-01-06 |
| 1790141885 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 212 Turning Leaf Cir, Belleville, IL 62221-6747 | 2016-01-06 |
| 1790141794 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 867 County Road 2150 E, Fairfield, IL 62837-2824 | 2016-01-06 |
| 1255797254 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 9135 N Spring Garden Ln, Mount Vernon, IL 62864-6624 | 2016-01-06 |
| Find all providers with the same taxonomy | ||||
| City | OAK FOREST |
| Zip Code | 60452 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.