Provider Demographics
NPI:1881911543
Name:HEPHZIBAH CHILDREN'S ASSOCIATION
Entity type:Organization
Organization Name:HEPHZIBAH CHILDREN'S ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERRY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-649-7100
Mailing Address - Street 1:1144 LAKE ST FL 5
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-6706
Mailing Address - Country:US
Mailing Address - Phone:708-649-7140
Mailing Address - Fax:708-649-7194
Practice Address - Street 1:1144 LAKE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-6705
Practice Address - Country:US
Practice Address - Phone:708-649-7140
Practice Address - Fax:708-649-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)