HAZEL BLAND PROMISE CENTER (NPI# 1235580564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235580564 |
| Entity Type | Organization |
| Organization Name | HAZEL BLAND PROMISE CENTER |
| Practice Address |
2900 State St East Saint Louis IL 62205-2234 |
| Practice Telephone | 6182743500 |
| Mailing Telephone | 6182743500 |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2016-06-28 |
| Authorized Official Name | MS. VIVIAN E. THOMPSON (FAMILY SUPPORT UNIT DIRECTOR) |
| Authorized Official Telephone | 6182743500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 199200170S | IL | Residential Treatment Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | HAZEL BLAND PROMISE CENTER | 2900 State St, East Saint Louis, IL 62205-2234 |
| Street Address |
2900 STATE ST |
| City | EAST SAINT LOUIS |
| State | IL |
| Zip Code | 62205-2234 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790156610 | Lessie Bates Davis Neighborhood House | Registered Nurse | 1200 North 13th Street, East Saint Louis, IL 62205 | 2015-10-19 |
| 1114047859 | Herschel Lee Garrett Jr. | Dentist | 4020 Caseyville Ave, East St Louis, IL 62205 | 2007-03-29 |
| 1376871103 | Toni M. Jackson | Massage Therapist | 4806 State St, Home Office, East Saint Louis, IL 62205-1355 | 2009-12-07 |
| 1811347362 | Destinee Hope Grove | Specialist/Technologist | 4901 State St, East Saint Louis, IL 62205-1356 | 2016-06-15 |
| 1053963470 | Stephanie Michelle Tate-patterson | Nurse Practitioner | 4901 State St, East Saint Louis, IL 62205-1356 | 2019-07-16 |
| 1710406962 | Christa R Dyson-spiller | Nurse Practitioner | 4901 State St, East Saint Louis, IL 62205-1356 | 2017-09-19 |
| 1558344986 | Gerard X Blaise | Dentist | 4601 State St, Ste 300, East Saint Louis, IL 62205-1359 | 2005-11-21 |
| 1013269737 | Illinois Express Home Care | In Home Supportive Care | 4601 State St, East Saint Louis, IL 62205-1359 | 2012-10-04 |
| 1427227891 | Comprehensive Mental Health Center of St. Clair County, Inc. | Community/Behavioral Health | 4601 State St, East Saint Louis, IL 62205-1359 | 2008-02-29 |
| 1801065289 | Comprehensive Mental Health Center of St. Clair County, Inc. | Community/Behavioral Health | 4601 State St, East Saint Louis, IL 62205-1359 | 2008-02-29 |
| Find all providers in zip 62205 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275131419 | Foatex Health Cilacare | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 823 163rd St, Calumet City, IL 60409-5915 | 2020-10-10 |
| 1053949404 | A Great Place To Stay LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 35580 N Knowles Rd, Lake Villa, IL 60046-9026 | 2020-03-31 |
| 1255966602 | Infinicare LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1939 Waukegan Rd Ste 300, Glenview, IL 60025-1758 | 2020-03-05 |
| 1023643772 | Supporting Community Independence | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1 Polo Grounds Ct, Bethalto, IL 62010-2623 | 2020-03-03 |
| 1770116287 | Universal Homes LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12101 S La Salle St, Chicago, IL 60628-6618 | 2020-02-13 |
| 1760014625 | Tomeka R Morgan | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11543 S Ashland Ave, Chicago, IL 60643-5001 | 2020-02-10 |
| 1487292660 | Shalom Home Health Ltd | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8147 Seminole Ct, Orland Park, IL 60462-4919 | 2019-12-18 |
| 1447894613 | Compassionate Living Home Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2625 Butterfield Rd Ste 314e, Oak Brook, IL 60523-1234 | 2019-10-31 |
| 1417599945 | Miracle Comprehensive Serivces | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4440 Lincoln Hwy Ste 205, Matteson, IL 60443-3803 | 2019-10-16 |
| 1609435072 | Bliss Haven, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1304 Durham St, Johnston City, IL 62951-2043 | 2019-06-10 |
| Find all providers with the same taxonomy | ||||
| City | EAST SAINT LOUIS |
| Zip Code | 62205 |
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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.