Healthcare Provider Details

I. General information

NPI: 1790257723
Provider Name (Legal Business Name): EPIC COMMIUNITY DEVELOPMENT CENTER, INCORPORTED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 MAIN ST
PARK FOREST IL
60466-2098
US

IV. Provider business mailing address

264 MAIN ST
PARK FOREST IL
60466-2098
US

V. Phone/Fax

Practice location:
  • Phone: 708-991-2221
  • Fax: 708-589-1368
Mailing address:
  • Phone: 708-991-2221
  • Fax: 708-991-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: ALBERT COOPER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 708-674-6238