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General NPI Number Information
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NPI Number | 1386942274
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Entity Type | Organization
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Legal Business Name | CHICAGO FAMILY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 9119 S EXCHANGE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4225
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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 | 9119 S EXCHANGE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4225
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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 | CREDENTIALING MANAGER
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Name | MR. BRANDON TAYLOR
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Credential | CPCS
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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