Healthcare Provider Details

I. General information

NPI: 1841555620
Provider Name (Legal Business Name): HOLISTIC COMMUNITY OUTREACH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 S WESTERN AVE
CHICAGO IL
60620-5937
US

IV. Provider business mailing address

8100 S WESTERN AVE
CHICAGO IL
60620-5937
US

V. Phone/Fax

Practice location:
  • Phone: 773-434-6070
  • Fax: 773-434-6382
Mailing address:
  • Phone: 773-434-6070
  • Fax: 773-434-6382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: THELMA JEAN CONNER
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 773-434-6370