Healthcare Provider Details

I. General information

NPI: 1245842863
Provider Name (Legal Business Name): FRIEND FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E 51ST ST
CHICAGO IL
60615-3509
US

IV. Provider business mailing address

PO BOX 19351
CHICAGO IL
60619-0266
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-0660
  • Fax: 773-834-3756
Mailing address:
  • Phone: 772-702-0660
  • Fax: 773-834-3756

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: ANGEL MCREYNOLDS
Title or Position: DIR. OF PROVIDER SERVICES
Credential:
Phone: 773-795-2260