Healthcare Provider Details

I. General information

NPI: 1871626713
Provider Name (Legal Business Name): FOLA COMMUNITY ACTION SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 S ASHLAND AVE
CHICAGO IL
60620-4317
US

IV. Provider business mailing address

8014 S ASHLAND AVE
CHICAGO IL
60620-4317
US

V. Phone/Fax

Practice location:
  • Phone: 773-487-4310
  • Fax: 773-487-4320
Mailing address:
  • Phone: 773-487-4310
  • Fax: 773-487-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: OLUFOLAKE OLADEINDE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-487-4310