Healthcare Provider Details

I. General information

NPI: 1700135266
Provider Name (Legal Business Name): FAMILY SERVICE & MHC OF CICERO AT CICERO HEALTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 S 49TH AVE
CICERO IL
60804-2460
US

IV. Provider business mailing address

5341 W CERMAK RD
CICERO IL
60804-2817
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-3600
  • Fax:
Mailing address:
  • Phone: 708-656-6430
  • Fax: 708-656-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LORENA NAVARRETE
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-656-6430