| Reestablishing Hope Inc | |
|
17577 Kedzie Ave Hazel Crest IL 60429-2051 | |
| (815) 418-6577 | |
| Not Available |
| Full Name | Reestablishing Hope Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 17577 Kedzie Ave, Hazel Crest, Illinois |
| Authorized Official Name and Position | Mary A Camper (CEO) |
| Authorized Official Contact | 8154186577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reestablishing Hope Inc 3850 Dewey Ave Richton Park IL 60471-2563 Ph: (815) 418-6577 | Reestablishing Hope Inc 17577 Kedzie Ave Hazel Crest IL 60429-2051 Ph: (815) 418-6577 |
| NPI Number | 1528531639 |
|---|---|
| Provider Enumeration Date | 01/10/2019 |
| Last Update Date | 12/01/2022 |
| Certification Date | 12/01/2022 |
| Medicare PECOS PAC ID | 8224433727 |
|---|---|
| Medicare Enrollment ID | O20210821000363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528531639 | NPI | - | NPPES |
| 14391234 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Mary A Camper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417420696 PECOS PAC ID: 9133524630 Enrollment ID: I20210821000376 |
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