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NPI Code Detail

MEDICARE: FRIEND FAMILY HEALTH CENTER INC

MEDICARE: FRIEND FAMILY HEALTH CENTER INC
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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1477175305
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRIEND FAMILY HEALTH CENTER INC
Provider Business Mailing Address
First Line : PO BOX 19351
Second Line :
City : CHICAGO
State : IL
Zip : 60619-0266
Country : US
Telephone Number : 773-795-2260
Fax Number : 773-834-3756
Provider Business Practice Location Address
First Line : 1140 W 79TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60620-3029
Country : US
Telephone Number : 773-702-0660
Fax Number : 773-834-3756
Authorized Official
Title or Position : DIR. OF PROVIDER SERVICES
Name : ANGEL MCREYNOLDS
Credential :
Telephone Number : 773-795-2260
Provider Enumeration Date : 05/14/2020
Last Update Date : 05/14/2020

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Directions to “FRIEND FAMILY HEALTH CENTER INC ” Practice Location

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