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NPI Code Detail

MEDICARE: CHICAGO DEPARTMENT OF PUBLIC HEALTH

MEDICARE: CHICAGO DEPARTMENT OF PUBLIC HEALTH
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)IL

General Provider Information

NPI Number : 1255333639
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO DEPARTMENT OF PUBLIC HEALTH
Provider Business Mailing Address
First Line : 333 S STATE ST
Second Line : REVENUE #200
City : CHICAGO
State : IL
Zip : 60604-3900
Country : US
Telephone Number : 312-747-9443
Fax Number : 312-747-9447
Provider Business Practice Location Address
First Line : 1140 W 79TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60620-3029
Country : US
Telephone Number : 312-747-0881
Fax Number : 312-747-7796
Authorized Official
Title or Position : DIRECTOR OF REVENUE
Name : MRS. SARAI M JACKSON
Credential :
Telephone Number : 312-747-9443
Provider Enumeration Date : 08/15/2005
Last Update Date : 08/22/2020

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Directions to “CHICAGO DEPARTMENT OF PUBLIC HEALTH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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