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General NPI Number Information
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NPI Number | 1417676453
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Entity Type | Organization
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Legal Business Name | SIDNEY CHARITY FOUNDATION
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1167 E 61ST ST APT 1
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City | CHICAGO
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State | IL
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Zip | 60637-5919
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Country | US
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Telephone | 312-508-3829
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 W TAYLOR ST STE 1607
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City | CHICAGO
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State | IL
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Zip | 60607-4623
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Country | US
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Telephone | 312-702-0121
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHAKA HOLLEY
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Credential | LCSW
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Telephone | 312-508-3829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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