Healthcare Provider Details

I. General information

NPI: 1487963732
Provider Name (Legal Business Name): PILSEN LITTLE VILLAGE MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W CERMAK RD
CHICAGO IL
60608-4115
US

IV. Provider business mailing address

2319 S DAMEN AVE
CHICAGO IL
60608-4209
US

V. Phone/Fax

Practice location:
  • Phone: 773-890-0645
  • Fax: 773-890-1257
Mailing address:
  • Phone: 773-579-0832
  • Fax: 773-579-0762

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 State

VIII. Authorized Official

Name: DR. FRANCISCO CISNEROS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-579-0832