MEDICARE: LAWNDALE CHRISTIAN HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103TC0700X	Clinical Psychologist
3	122300000X	Dentist
4	133N00000X	Nutritionist
5	152W00000X	Optometrist
6	164W00000X	Licensed Practical Nurse
7	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1831590421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWNDALE CHRISTIAN HEALTH CENTER

Provider Business Mailing Address
First Line	:	3860 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2460
Country	:	US
Telephone Number	:	872-588-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3219 W CARROLL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2031
Country	:	US
Telephone Number	:	872-588-3000
Fax Number	:

Authorized Official
Title or Position	:	ASST DIR OF PATIENT ACCOUNTING
Name	:	KAREN RENEE JOHNSON
Credential	:
Telephone Number	:	872-588-3000

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	07/01/2021

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Directions to “LAWNDALE CHRISTIAN HEALTH CENTER ” Practice Location

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