MEDICARE: UCAN

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	253J00000X	Foster Care Agency	12162610	IL
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1447584990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCAN

Provider Business Mailing Address
First Line	:	3605 W. FILLMORE ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624
Country	:	US
Telephone Number	:	773-588-0180
Fax Number	:	773-588-7762

Provider Business Practice Location Address
First Line	:	3605 W. FILLMORE ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-4309
Country	:	US
Telephone Number	:	773-588-0180
Fax Number	:	773-588-7762

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ZACK SCHRANTZ
Credential	:
Telephone Number	:	773-588-0180

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	05/03/2019

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Directions to “UCAN ” Practice Location

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