Healthcare Provider Details

I. General information

NPI: 1437072089
Provider Name (Legal Business Name): INFANT WELFARE SOCIETY OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 N CENTRAL AVE
CHICAGO IL
60639-1324
US

IV. Provider business mailing address

3600 W FULLERTON AVE
CHICAGO IL
60647-2319
US

V. Phone/Fax

Practice location:
  • Phone: 773-782-2800
  • Fax:
Mailing address:
  • Phone: 773-782-2800
  • Fax:

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: HEIDI ORTOLAZA-ALVEAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 773-782-2800