MEDICARE: PCC COMMUNITY WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1295385490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PCC COMMUNITY WELLNESS CENTER

Provider Business Mailing Address
First Line	:	6201 ROOSEVELT RD
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-1108
Country	:	US
Telephone Number	:	708-406-3056
Fax Number	:

Provider Business Practice Location Address
First Line	:	4534 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-3027
Country	:	US
Telephone Number	:	708-406-3056
Fax Number	:	708-406-3051

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	ALYSSA N SIANGHIO
Credential	:
Telephone Number	:	708-383-9786

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	01/09/2026

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