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General NPI Number Information
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NPI Number | 1710304480
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Entity Type | Organization
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Legal Business Name | EXPANDED MENTAL HEALTH SERVICES OF CHICAGO NFP
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 4141 N KEDZIE AVE SUITE 2
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City | CHICAGO
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State | IL
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Zip | 60618-2477
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Country | US
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Telephone | 773-754-0577
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Fax |
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Provider Business Mailing Address
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Address Line | 4141 N KEDZIE AVE SUITE 2
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City | CHICAGO
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State | IL
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Zip | 60618-2477
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Country | US
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Telephone | 773-754-0577
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Fax |
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Authorized Official
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Title or Position | OPERATIONS & FINANCE
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Name | VERONICA PEREZ
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Credential |
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Telephone | 773-754-0577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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