Healthcare Provider Details

I. General information

NPI: 1982448221
Provider Name (Legal Business Name): EXPANDED MENTAL HEALTH SERVICES OF CHICAGO NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W ARMITAGE AVE.
CHICAGO IL
60647
US

IV. Provider business mailing address

3555 W ARMITAGE AVE.
CHICAGO IL
60647
US

V. Phone/Fax

Practice location:
  • Phone: 774-754-0577
  • Fax:
Mailing address:
  • Phone: 774-754-0577
  • Fax:

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VERONICA PEREZ
Title or Position: OPERATIONS & FINANCE MANAGER
Credential:
Phone: 773-754-0577