Healthcare Provider Details

I. General information

NPI: 1790165629
Provider Name (Legal Business Name): ADA S MCKINLEY COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1863 S WABASH AVE
CHICAGO IL
60616-1614
US

IV. Provider business mailing address

1359 W WASHINGTON BLVD
CHICAGO IL
60607-1905
US

V. Phone/Fax

Practice location:
  • Phone: 312-326-1773
  • Fax: 312-326-5136
Mailing address:
  • Phone: 312-385-2000
  • Fax: 312-554-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMAL MALONE
Title or Position: CEO
Credential:
Phone: 312-385-2000