MEDICARE: SOUTH SIDE HEALTHY COMMUNITY ORGANIZATION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1124955265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SIDE HEALTHY COMMUNITY ORGANIZATION, INC

Provider Business Mailing Address
First Line	:	7936 S COTTAGE GROVE AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3911
Country	:	US
Telephone Number	:	872-274-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	7936 S COTTAGE GROVE AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3911
Country	:	US
Telephone Number	:	872-274-4688
Fax Number	:

Authorized Official
Title or Position	:	VP PEOPLE & OPERATIONS
Name	:	STEPHANIE MICHELLE BARNETT
Credential	:
Telephone Number	:	773-885-5507

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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