Healthcare Provider Details

I. General information

NPI: 1649657719
Provider Name (Legal Business Name): RINCON FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 W GRAND AVE
CHICAGO IL
60651-2004
US

IV. Provider business mailing address

3809 W GRAND AVE
CHICAGO IL
60651-2004
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-0200
  • Fax: 773-276-4226
Mailing address:
  • Phone: 773-276-0200
  • Fax: 773-276-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number004880004
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. EDDY BORRAYO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-564-9070