Provider Demographics
NPI:1174066617
Name:ILLINOIS HOUSING AND DISABILITY SERVICES
Entity type:Organization
Organization Name:ILLINOIS HOUSING AND DISABILITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MYROGENE MAE
Authorized Official - Middle Name:SAAGUNDO
Authorized Official - Last Name:GABIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:630-470-9668
Mailing Address - Street 1:710 E OGDEN AVE SUITE 690
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-470-9668
Mailing Address - Fax:630-470-9133
Practice Address - Street 1:710 E OGDEN AVE SUITE 690
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-470-9668
Practice Address - Fax:630-470-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201600006C320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities