Healthcare Provider Details

I. General information

NPI: 1457256703
Provider Name (Legal Business Name): UCAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 W GRAND AVE
CHICAGO IL
60622-4324
US

IV. Provider business mailing address

3605 W FILLMORE ST
CHICAGO IL
60624-4310
US

V. Phone/Fax

Practice location:
  • Phone: 773-615-4787
  • Fax:
Mailing address:
  • Phone: 773-615-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: TINA RUIZ
Title or Position: VP OF QI
Credential: LCSW
Phone: 312-806-9232