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General NPI Number Information
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NPI Number | 1699065813
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Entity Type | Organization
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Legal Business Name | PRIMO CENTER FOR WOMEN AND CHILDREN
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 6212 S SANGAMON ST
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City | CHICAGO
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State | IL
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Zip | 60621-2006
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Country | US
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Telephone | 773-826-7991
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Fax | 773-471-6099
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Provider Business Mailing Address
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Address Line | 6212 S SANGAMON ST
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City | CHICAGO
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State | IL
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Zip | 60621-2006
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Country | US
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Telephone | 773-826-7991
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Fax | 773-471-6099
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Authorized Official
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Title or Position | CEO
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Name | MS. CHRISTINE MARIE ACHRE
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Credential | LCPC
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Telephone | 773-722-0544
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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 | 180005578
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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 |
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License Number State |
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