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General NPI Number Information
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NPI Number | 1689158271
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Entity Type | Organization
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Legal Business Name | PCC COMMUNITY WELLNESS CENTER
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 14 LAKE ST
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City | OAK PARK
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State | IL
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Zip | 60302-2606
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Country | US
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Telephone | 708-406-3056
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Fax | 708-406-3051
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Provider Business Mailing Address
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Address Line | 6201 ROOSEVELT RD
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City | BERWYN
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State | IL
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Zip | 60402-1108
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Country | US
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Telephone | 708-406-3056
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Fax | 708-406-3051
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Authorized Official
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Title or Position | FINANCIAL ANALYST
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Name | KATHLEEN A HAND
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Credential |
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Telephone | 708-406-3056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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