Healthcare Provider Details

I. General information

NPI: 1427271568
Provider Name (Legal Business Name): RINCON FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 W GRAND AVE
CHICAGO IL
60651
US

IV. Provider business mailing address

3942 W NORTH AVE
CHICAGO IL
60647-4639
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-0200
  • Fax: 773-276-4226
Mailing address:
  • Phone: 773-564-9070
  • Fax: 773-249-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDDY BORRAYO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-564-9070