Healthcare Provider Details

I. General information

NPI: 1245289214
Provider Name (Legal Business Name): LAWNDALE CHRISTIAN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 W OGDEN AVE
CHICAGO IL
60623-2460
US

IV. Provider business mailing address

3860 W OGDEN AVE
CHICAGO IL
60623-2460
US

V. Phone/Fax

Practice location:
  • Phone: 773-843-2705
  • Fax: 773-843-2704
Mailing address:
  • Phone:
  • Fax: 773-843-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KAREN JOHNSON
Title or Position: ASST DIR OF PATIENT ACCOUNTING
Credential:
Phone: 872-588-3062