Healthcare Provider Details

I. General information

NPI: 1942553490
Provider Name (Legal Business Name): ADA S. MCKINLEY COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 S MORGAN ST
CHICAGO IL
60621-1201
US

IV. Provider business mailing address

1359 W WASHINGTON BLVD
CHICAGO IL
60607-1905
US

V. Phone/Fax

Practice location:
  • Phone: 773-994-0833
  • Fax: 773-994-8716
Mailing address:
  • Phone: 312-385-2000
  • Fax: 312-554-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KEN FRIES
Title or Position: DIR QA&C
Credential:
Phone: 312-385-2022