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General NPI Number Information
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NPI Number | 1346803111
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Entity Type | Organization
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Legal Business Name | UCAN
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 212 S FRANCISCO AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3618
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Country | US
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Telephone | 773-696-3210
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Fax | 773-217-9364
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Provider Business Mailing Address
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Address Line | 3605 W FILLMORE ST
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City | CHICAGO
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State | IL
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Zip | 60624-4310
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ZACK SCHRANTZ
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Credential |
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Telephone | 773-588-0180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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