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General NPI Number Information
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NPI Number | 1790160695
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Entity Type | Organization
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Legal Business Name | ADELANTE COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 6840 OGDEN AVE
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City | BERWYN
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State | IL
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Zip | 60402-3645
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Country | US
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Telephone | 708-797-3279
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Fax | 708-775-6060
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Provider Business Mailing Address
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Address Line | 5625 BENTLEY AVE
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-1509
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL E. ALVA
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Credential | MD
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Telephone | 708-797-3279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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