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General NPI Number Information
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NPI Number | 1467685669
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Entity Type | Organization
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Legal Business Name | ASIAN HUMAN SERVICES OF CHICAGO, INC.
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 1643 W BRYN MAWR AVE
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City | CHICAGO
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State | IL
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Zip | 60660-4106
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Country | US
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Telephone | 773-433-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 4753 N BROADWAY ST STE 700
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City | CHICAGO
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State | IL
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Zip | 60640-4995
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Country | US
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Telephone | 773-293-8430
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Fax | 773-728-4751
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. CRAIG MAKI
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Credential | PH.D
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Telephone | 773-293-8468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-5003-001-A
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License Number State | IL
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Taxonomy #2
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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 | A50030001A
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License Number State | IL
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