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General NPI Number Information
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NPI Number | 1386981264
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Entity Type | Organization
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Legal Business Name | CENTRO DE SALUD Y ESPERANZA
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 2001 S CALIFORNIA AVE SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60608-2486
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Country | US
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Telephone | 773-584-6133
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Fax |
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Provider Business Mailing Address
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Address Line | 3059 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4131
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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 | CEO
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Name | DANIEL FULWILER
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Credential |
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Telephone | 773-584-6130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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