Healthcare Provider Details

I. General information

NPI: 1740730266
Provider Name (Legal Business Name): ASIAN HUMAN SERVICES OF CHICAGO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8565 W DEMPSTER ST STE 104
NILES IL
60714-1406
US

IV. Provider business mailing address

4753 N BROADWAY ST STE 700
CHICAGO IL
60640-4995
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-0300
  • Fax:
Mailing address:
  • Phone: 773-293-8430
  • Fax: 773-728-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberA-5003-0001-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-5003-0001-A
License Number StateIL

VIII. Authorized Official

Name: DR. CRAIG MAKI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 773-293-8448