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General NPI Number Information
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NPI Number | 1760792790
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Entity Type | Organization
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Legal Business Name | PILSEN LITTLE VILLAGE MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 2635 W 23RD ST
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City | CHICAGO
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State | IL
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Zip | 60608-3609
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Country | US
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Telephone | 773-927-1228
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Fax | 773-927-0237
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Provider Business Mailing Address
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Address Line | 2319 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-4209
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Country | US
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Telephone | 773-579-0832
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Fax | 773-579-0762
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. FRANCISCO CISNEROS
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Credential |
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Telephone | 773-579-0832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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