1932301439 NPI number — CHICAGO FAMILY HEALTH CENTER

Table of content: (NPI 1932301439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932301439 NPI number — CHICAGO FAMILY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGO FAMILY HEALTH 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:
1932301439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9119 S EXCHANGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60617-4225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-768-5000
Provider Business Mailing Address Fax Number:
773-374-1621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2320 E 93RD ST
Provider Second Line Business Practice Location Address:
FLOOR 1
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60617-3983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-967-1135
Provider Business Practice Location Address Fax Number:
773-374-1621
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
AMELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
773-768-5000

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  1769357 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1769357 . This is a "CITY LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 14D1059438 . This is a "CLIA LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com