Healthcare Provider Details

I. General information

NPI: 1497747026
Provider Name (Legal Business Name): CHICAGO REACH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 W AUGUSTA BLVD
CHICAGO IL
60651-3302
US

IV. Provider business mailing address

4501 W AUGUSTA BLVD
CHICAGO IL
60651-3302
US

V. Phone/Fax

Practice location:
  • Phone: 773-252-8989
  • Fax: 773-252-8995
Mailing address:
  • Phone: 773-252-8989
  • Fax: 773-252-8995

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: MRS. KAREN L GRICUS
Title or Position: COO/RN/MS
Credential: RN
Phone: 773-252-8989