Healthcare Provider Details

I. General information

NPI: 1164501896
Provider Name (Legal Business Name): ACCESS COMMUNITY HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 S CICERO AVE
CICERO IL
60804-3638
US

IV. Provider business mailing address

600 W FULTON SUITE 200
CHICAGO IL
60661-1262
US

V. Phone/Fax

Practice location:
  • Phone: 708-780-9777
  • Fax: 708-780-9787
Mailing address:
  • Phone: 312-526-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DONNA THOMPSON
Title or Position: CEO
Credential:
Phone: 312-526-2051