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General NPI Number Information
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NPI Number | 1942935986
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Entity Type | Organization
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Legal Business Name | WILL COUNTY COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 350 BLAIR LN
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1801
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Country | US
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Telephone | 815-727-5961
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 NEAL AVE
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City | JOLIET
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State | IL
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Zip | 60433-2548
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Country | US
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Telephone | 815-727-5961
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Fax | 815-846-8932
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SUSAN OLENEK
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Credential |
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Telephone | 815-740-8982
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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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