Healthcare Provider Details

I. General information

NPI: 1447584990
Provider Name (Legal Business Name): UCAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 W. FILLMORE ST.
CHICAGO IL
60624-4309
US

IV. Provider business mailing address

3605 W. FILLMORE ST.
CHICAGO IL
60624
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-0180
  • Fax: 773-588-7762
Mailing address:
  • Phone: 773-588-0180
  • Fax: 773-588-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number12162610
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ZACK SCHRANTZ
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-588-0180