Healthcare Provider Details

I. General information

NPI: 1801067368
Provider Name (Legal Business Name): FAMILY SERVICE & MENTAL HEALTH SERVICE OF CICERO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 W CERMAK RD 201
CICERO IL
60804-2817
US

IV. Provider business mailing address

5341 W CERMAK RD 201
CICERO IL
60804-2817
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-6430
  • Fax:
Mailing address:
  • Phone: 708-656-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN MORGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 708-656-6430