Healthcare Provider Details

I. General information

NPI: 1104462464
Provider Name (Legal Business Name): ASIAN HUMAN SERVICES, PALATINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 N RAND RD STE 530
PALATINE IL
60074-2919
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 773-293-8194
  • Fax:
Mailing address:
  • Phone: 773-293-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHEN AN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 847-924-4768