1861042715 NPI number — NEW HOPE COMMUNITY SERVICE CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861042715 NPI number — NEW HOPE COMMUNITY SERVICE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HOPE COMMUNITY SERVICE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861042715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NEW HOPE COMMUNITY SERVICE CENTER
Provider Second Line Business Mailing Address:
2559 WEST 79TH
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-737-9555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NEW HOPE COMMUNITY SERVICE CENTER
Provider Second Line Business Practice Location Address:
2559 WEST 79TH
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-737-9555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BODLEY
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL BILL
Authorized Official Telephone Number:
773-737-9555

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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