Healthcare Provider Details

I. General information

NPI: 1790160695
Provider Name (Legal Business Name): ADELANTE COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 OGDEN AVE
BERWYN IL
60402-3645
US

IV. Provider business mailing address

5625 BENTLEY AVE
CLARENDON HILLS IL
60514-1509
US

V. Phone/Fax

Practice location:
  • Phone: 708-797-3279
  • Fax: 708-775-6060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL E. ALVA
Title or Position: PRESIDENT
Credential: MD
Phone: 708-797-3279