Provider Demographics
NPI:1447533195
Name:COOK COUNTY ADULT PROBATION
Entity type:Organization
Organization Name:COOK COUNTY ADULT PROBATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF PROBAITON OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-674-2871
Mailing Address - Street 1:69 W WASHINGTON ST
Mailing Address - Street 2:SUITE 1940
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3134
Mailing Address - Country:US
Mailing Address - Phone:312-603-0258
Mailing Address - Fax:312-603-9992
Practice Address - Street 1:5600 OLD ORCHARD RD
Practice Address - Street 2:ROOM 249
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1051
Practice Address - Country:US
Practice Address - Phone:773-674-3282
Practice Address - Fax:773-674-4913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK COUNTY ADULT PROBATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04038Medicaid