MEDICARE: SISTA AFYA COMMUNITY CARE NFP

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1548975428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SISTA AFYA COMMUNITY CARE NFP

Provider Business Mailing Address
First Line	:	5022 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-5328
Country	:	US
Telephone Number	:	708-292-8730
Fax Number	:

Provider Business Practice Location Address
First Line	:	5022 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-5328
Country	:	US
Telephone Number	:	708-292-8730
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CAMESHA LYNETTE JONES BRANDON
Credential	:	LCSW
Telephone Number	:	240-533-2876

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	02/26/2025

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