Healthcare Provider Details

I. General information

NPI: 1912584327
Provider Name (Legal Business Name): BURTON HOMES COMMUNITY OUTREACH NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 07/29/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9204 S COMMERCIAL AVE STE 308
CHICAGO IL
60617-2197
US

IV. Provider business mailing address

10208 S INDIANAPOLIS AVE
CHICAGO IL
60617-6033
US

V. Phone/Fax

Practice location:
  • Phone: 312-404-7184
  • Fax:
Mailing address:
  • Phone: 224-216-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIANA SMITH
Title or Position: PRESIDENT/ CEO
Credential:
Phone: 312-404-7184