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General NPI Number Information
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NPI Number | 1437401668
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Entity Type | Organization
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Legal Business Name | ADA S. MCKINLEY COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 6600 S STEWART AVE
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City | CHICAGO
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State | IL
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Zip | 60621-3112
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Country | US
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Telephone | 773-994-0775
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Fax | 773-994-8722
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Provider Business Mailing Address
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Address Line | 1359 W WASHINGTON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-1905
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Country | US
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Telephone | 312-385-2000
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Fax | 312-554-0292
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Authorized Official
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Title or Position | DIR QA&C
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Name | KEN FRIES
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Credential |
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Telephone | 630-744-9431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 001
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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