Healthcare Provider Details

I. General information

NPI: 1265705990
Provider Name (Legal Business Name): FAMILY SERVICE AND MENTAL HEALTH CENTER OF CICERO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LAKE ST
OAK PARK IL
60302-2612
US

IV. Provider business mailing address

5341 W CERMAK RD
CICERO IL
60804-2817
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-0528
  • Fax: 708-848-5855
Mailing address:
  • Phone: 708-656-6430
  • Fax: 708-656-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIL

VIII. Authorized Official

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