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NPI Code Detail

MEDICARE: PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.

MEDICARE: PILSEN-LITTLE VILLAGE COMMUNITY MENTAL 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
1251S00000XCommunity/Behavioral Health AgencyA-0155-0001-AIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2A-0155-0001-AOTHERILSTATE CONTRACTS

General Provider Information

NPI Number : 1508034349
Entity Type Code : Organization
Provider Name (Legal Business Name) : PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : 2319 S DAMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-4209
Country : US
Telephone Number : 773-579-0832
Fax Number : 773-579-0762
Provider Business Practice Location Address
First Line : 2319 S DAMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-4209
Country : US
Telephone Number : 773-579-0832
Fax Number : 773-579-0762
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. FRANCISCO CISNEROS
Credential : MA, CADC
Telephone Number : 773-579-0832
Provider Enumeration Date : 02/14/2008
Last Update Date : 02/14/2008

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Directions to “PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC. ” Practice Location

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