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General NPI Number Information
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NPI Number | 1982599346
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Entity Type | Organization
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Legal Business Name | PCC COMMUNITY WELLNESS CENTER
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 5801 W CORCORAN PL
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City | CHICAGO
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State | IL
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Zip | 60644-1854
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Country | US
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Telephone | 773-285-6400
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Fax | 877-669-0519
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Provider Business Mailing Address
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Address Line | 5801 W CORCORAN PL
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City | CHICAGO
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State | IL
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Zip | 60644-1854
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Country | US
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Telephone | 773-285-6400
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Fax | 877-669-0519
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | ALYSSA N SIANGHIO
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Credential |
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Telephone | 708-383-9786
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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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