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General NPI Number Information
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NPI Number | 1891921623
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Entity Type | Organization
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Legal Business Name | FRIEND FAMILY HEALTH CENTER INC
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 4802 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60609-4233
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Country | US
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Telephone | 773-376-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 2436 W 47TH ST
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City | CHICAGO
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State | IL
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Zip | 60632-1336
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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 | BILLING/PROVIDER SERVICES MGR
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Name | ANGEL MCREYNOLDS
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Credential |
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Telephone | 773-705-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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