SHAW COMMUNITY INTEGRATION SERVICES (NPI# 1710519046) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710519046 |
| Entity Type | Organization |
| Organization Name | SHAW COMMUNITY INTEGRATION SERVICES |
| Practice Address |
8119 S Vernon Ave Chicago IL 60619-4913 |
| Mailing Address |
8119 S Vernon Ave # 1 Chicago IL 60619-4913 |
| Practice Telephone | 7739521965 |
| Practice Fax Number | 7088109792 |
| Mailing Telephone | 7739521965 |
| Mailing Fax Number | 7088109792 |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2020-02-05 |
| Authorized Official Name | MS. RHONDA JEFFERSON (REGISTERED NURSE) |
| Authorized Official Telephone | 7739521965 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
Nursing Service Providers | ||
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| SCIS Agency | Doing Business As Name - Organization |
| Street Address |
8119 S VERNON AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60619-4913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457985061 | Tonia Dorsey | Durable Medical Equipment & Medical Supplies | 951 E 80th Street, Apt 1, Chicago, IL 60619 | 2020-02-24 |
| 1821635509 | Lisa Strader | Technician | 8605 S. Dorchester, Chicago, IL 60619 | 2019-12-02 |
| 1821647579 | Deborah Joves | Technician | 8258 S. Woodlawn Ave, Chicago, IL 60619 | 2019-09-05 |
| 1194372458 | Cognitive Focus Centers, Inc. | Clinic/Center | 901 E 95th St, Chicago, IL 60619 | 2019-08-21 |
| 1588136360 | Zantraquilla Z Madkins | Transportation Broker | 7829 South Wabash, Chicago, IL 60619 | 2018-12-18 |
| 1619447497 | Bria Stanciel | Case Manager/Care Coordinator | 8419 S Cottage Grove, Chicago, IL 60619 | 2018-12-05 |
| 1184153520 | Jordane Kelley | Nurse's Aide | 7339 S Wabash Ave, Chicago, IL 60619 | 2017-06-08 |
| 1205362977 | Kristen Suing | Psychologist | 1111 E 87th St Ste 300, Chicago, IL 60619 | 2017-05-02 |
| 1720525280 | Senior Healthcare Services Inc | Physical Therapist | 9133 South Stoney Island, Chicago, IL 60619 | 2017-01-23 |
| 1932652567 | Md Orthotic & Prosthetic Laboratory, Inc. | Prosthetic/Orthotic Supplier | 1514 E 87th St Lowr Level, Chicago, IL 60619 | 2016-08-01 |
| Find all providers in zip 60619 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1457839821 | Adorn Health, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 190 South Lasalle Street, #2100, Chicago, IL 60603-0003 | 2018-07-30 |
| 1215423538 | Alyssa Jaye Saterfield | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1447 W Montrose Ave, Chicago, IL 60613-1348 | 2018-07-10 |
| 1336635135 | Essential Lifestyles LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7408 S Harvard Ave, Chicago, IL 60621-3424 | 2018-07-03 |
| 1184113987 | Ohana Community Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4931 W Thomas St, Chicago, IL 60651-3129 | 2018-05-07 |
| 1124523352 | Tylers Place | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7347 S Claremont Ave, Chicago, IL 60636-3627 | 2018-03-29 |
| 1992207724 | Universal Homes LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12512 S Wallace St, Chicago, IL 60628-7130 | 2018-03-07 |
| 1730623786 | A New Age Human Services Corp. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5328 W Parker Ave, Chicago, IL 60639-1521 | 2016-12-10 |
| 1831643121 | Lajaed Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8026 S Wood St, Chicago, IL 60620-4546 | 2016-08-04 |
| Find all providers in CHICAGO | ||||
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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.