Healthcare Provider Details

I. General information

NPI: 1336451079
Provider Name (Legal Business Name): ASIAN HUMAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 W PETERSON AVE
CHICAGO IL
60659-4100
US

IV. Provider business mailing address

4753 N BROADWAY ST SUITE 700
CHICAGO IL
60640-5266
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-0300
  • Fax: 773-761-0008
Mailing address:
  • Phone: 773-293-8430
  • Fax: 773-728-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-5003-0001-A
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberA50030001A
License Number StateIL

VIII. Authorized Official

Name: MR. CRAIG MAKI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PH.D
Phone: 773-293-8468