Healthcare Provider Details

I. General information

NPI: 1457525792
Provider Name (Legal Business Name): FRIEND FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 S PULASKI RD
CHICAGO IL
60629-4438
US

IV. Provider business mailing address

800 E 55TH ST
CHICAGO IL
60615-4906
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-0660
  • Fax: 773-702-4356
Mailing address:
  • Phone: 773-702-0660
  • Fax: 773-702-4356

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: SABRINA MOORE
Title or Position: CFO
Credential:
Phone: 773-702-5821