Healthcare Provider Details

I. General information

NPI: 1659128932
Provider Name (Legal Business Name): ESPERANZA HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 S CALIFORNIA AVE
CHICAGO IL
60632
US

IV. Provider business mailing address

2001 S CALIFORNIA AVE STE 100
CHICAGO IL
60608-2486
US

V. Phone/Fax

Practice location:
  • Phone: 773-584-6140
  • Fax:
Mailing address:
  • Phone: 773-640-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY SPREITZER
Title or Position: SR DIRECTOR OF FINANCE
Credential:
Phone: 773-584-6200