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General NPI Number Information
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NPI Number | 1154629848
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Entity Type | Organization
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Legal Business Name | CHICAGO FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 9119 S. EXCHANGE
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City | CHICAGO
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State | IL
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Zip | 60617-4321
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Country | US
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Telephone | 773-768-5000
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Fax | 773-768-6153
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Provider Business Mailing Address
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Address Line | 2454 W SUPERIOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-1214
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Country | US
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Telephone | 773-768-5000
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Fax | 773-768-6153
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Authorized Official
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Title or Position | SENIOR DIRECTOR
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Name | MS. LORAINE MORENO
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Credential | R.N.
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Telephone | 773-768-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number | 207Q00000
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License Number State | IL
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