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NPI Code Detail

MEDICARE: CHINESE AMERICAN SERVICE LEAGUE, INC.

MEDICARE: CHINESE AMERICAN SERVICE LEAGUE, 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
1101YP2500XProfessional Counselor
21041C0700XClinical Social Worker
3225X00000XOccupational Therapist
4253Z00000XIn Home Supportive Care Agency
5261QM0850XAdult Mental Health Clinic/Center
6261QM0855XAdolescent and Children Mental Health Clinic/Center
7261QA0600XAdult Day Care Clinic/Center
8341600000XAmbulance
9363LF0000XFamily Nurse Practitioner
10343900000XNon-emergency Medical Transport (VAN)
11376J00000XHomemaker

General Provider Information

NPI Number : 1902161490
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHINESE AMERICAN SERVICE LEAGUE, INC.
Provider Business Mailing Address
First Line : 2141 S TAN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1998
Country : US
Telephone Number : 312-791-0418
Fax Number : 312-791-0509
Provider Business Practice Location Address
First Line : 2141 S TAN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1998
Country : US
Telephone Number : 312-791-0418
Fax Number : 312-791-0509
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. JERED GREGORY PRUITT
Credential :
Telephone Number : 312-328-6606
Provider Enumeration Date : 07/10/2012
Last Update Date : 06/01/2026

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Directions to “CHINESE AMERICAN SERVICE LEAGUE, INC. ” Practice Location

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