Healthcare Provider Details

I. General information

NPI: 1669812582
Provider Name (Legal Business Name): ESPERANZA HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 S RICHMOND ST
CHICAGO IL
60629-2821
US

IV. Provider business mailing address

6550 S RICHMOND ST
CHICAGO IL
60629-2821
US

V. Phone/Fax

Practice location:
  • Phone: 773-584-6202
  • Fax:
Mailing address:
  • Phone: 773-584-6202
  • 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: JEFFREY MCINNES
Title or Position: DIRECTOR OF BILLING & PATIENT ACCES
Credential:
Phone: 773-640-5785