MEDICARE: RINCON FAMILY SERVICES

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	261QM2800X	Methadone Clinic
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1427271568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RINCON FAMILY SERVICES

Provider Business Mailing Address
First Line	:	3942 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4639
Country	:	US
Telephone Number	:	773-564-9070
Fax Number	:	773-249-9362

Provider Business Practice Location Address
First Line	:	3809 W GRAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651
Country	:	US
Telephone Number	:	773-276-0200
Fax Number	:	773-276-4226

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	EDDY BORRAYO
Credential	:
Telephone Number	:	773-564-9070

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	11/01/2018

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