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NPI Code Detail

MEDICARE: RINCON FAMILY SERVICES

MEDICARE: RINCON FAMILY SERVICES
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
1251S00000XCommunity/Behavioral Health Agency150.015028IL

General Provider Information

NPI Number : 1497120117
Entity Type Code : Organization
Provider Name (Legal Business Name) : RINCON FAMILY SERVICES
Provider Business Mailing Address
First Line : 515 N NOBLE ST APT 105
Second Line :
City : CHICAGO
State : IL
Zip : 60642-7400
Country : US
Telephone Number : 773-909-9096
Fax Number :
Provider Business Practice Location Address
First Line : 3710 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-4504
Country : US
Telephone Number : 773-564-9070
Fax Number :
Authorized Official
Title or Position : PRESIDENT / CHIEF EXECUTIVE OFFICER
Name : MR. ROLANDO CORREA
Credential :
Telephone Number : 773-564-9070
Provider Enumeration Date : 12/07/2015
Last Update Date : 12/07/2015

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Directions to “RINCON FAMILY SERVICES ” Practice Location

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