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General NPI Number Information
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NPI Number | 1245560788
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Entity Type | Organization
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Legal Business Name | YOUTH OUTREACH SERVICES
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 6117 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2023
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Country | US
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Telephone | 773-777-7112
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Fax | 708-652-5379
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Provider Business Mailing Address
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Address Line | 2411 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612-3534
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Country | US
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Telephone | 773-777-7112
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Fax | 773-777-7112
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RICK VELASQUEZ
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Credential | MSW
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Telephone | 773-777-7112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-0534-0006-A
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License Number State | IL
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