Healthcare Provider Details

I. General information

NPI: 1679212187
Provider Name (Legal Business Name): MIDWAY TURNING POINT COMMUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 75TH ST
CHICAGO IL
60619-2297
US

IV. Provider business mailing address

200 E 75TH ST
CHICAGO IL
60619-2297
US

V. Phone/Fax

Practice location:
  • Phone: 312-858-2550
  • Fax: 312-878-2291
Mailing address:
  • Phone: 312-535-4494
  • Fax: 312-878-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EUNICE T WALKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 312-489-4715