Healthcare Provider Details

I. General information

NPI: 1467685669
Provider Name (Legal Business Name): ASIAN HUMAN SERVICES OF CHICAGO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 W BRYN MAWR AVE
CHICAGO IL
60660-4106
US

IV. Provider business mailing address

4753 N BROADWAY ST STE 700
CHICAGO IL
60640-4995
US

V. Phone/Fax

Practice location:
  • Phone: 773-433-3530
  • Fax:
Mailing address:
  • Phone: 773-293-8430
  • Fax: 773-728-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberA50030001A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-5003-001-A
License Number StateIL

VIII. Authorized Official

Name: MR. CRAIG MAKI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PH.D
Phone: 773-293-8468