Healthcare Provider Details

I. General information

NPI: 1649976838
Provider Name (Legal Business Name): EVOLVING COMMUNITY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 75TH ST STE 600
CHICAGO IL
60619-2284
US

IV. Provider business mailing address

PO BOX 212
CRETE IL
60417-0212
US

V. Phone/Fax

Practice location:
  • Phone: 312-489-4715
  • Fax: 312-878-2291
Mailing address:
  • Phone: 312-489-4715
  • Fax: 312-878-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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