Healthcare Provider Details

I. General information

NPI: 1215394895
Provider Name (Legal Business Name): FRIEND FAMILY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 E 63RD STREET
CHICAGO IL
60637
US

IV. Provider business mailing address

800 E 55TH ST
CHICAGO IL
60615
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-0660
  • Fax:
Mailing address:
  • Phone: 773-702-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: SABRINA MOORE
Title or Position: CFO
Credential:
Phone: 773-702-2193