Healthcare Provider Details

I. General information

NPI: 1912459942
Provider Name (Legal Business Name): CHICAGO HOUSE AND SOCIAL SERVICE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 S MICHIGAN AVE
CHICAGO IL
60616-2102
US

IV. Provider business mailing address

2229 S MICHIGAN AVE
CHICAGO IL
60616-2102
US

V. Phone/Fax

Practice location:
  • Phone: 773-232-1370
  • Fax:
Mailing address:
  • Phone: 773-232-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TERRI WILKERSON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 773-232-1370