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General NPI Number Information
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NPI Number | 1649980947
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Entity Type | Organization
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Legal Business Name | CHINESE AMERICAN SERVICE LEAGUE, INC.
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 2141 S TAN CT
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City | CHICAGO
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State | IL
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Zip | 60616-1998
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Country | US
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Telephone | 312-808-0280
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Fax |
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Provider Business Mailing Address
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Address Line | 2141 S TAN CT
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City | CHICAGO
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State | IL
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Zip | 60616-1998
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Country | US
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Telephone | 312-808-0280
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JERED G PRUITT
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Credential |
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Telephone | 312-328-6606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service 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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health 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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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