MEDICARE: DEPAUL FAMILY & COMMUNITY 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1629246467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPAUL FAMILY & COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	2156 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8156
Country	:	US
Telephone Number	:	773-477-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	2156 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8156
Country	:	US
Telephone Number	:	773-477-5581
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. SHEILA C. RIBORDY
Credential	:	PH.D.
Telephone Number	:	773-325-7780

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	07/25/2008

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