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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740730456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RINCON FAMILY SERVICES

Provider Business Mailing Address
First Line	:	3710 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4504
Country	:	US
Telephone Number	:	773-564-9070
Fax Number	:	773-564-9197

Provider Business Practice Location 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

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

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	03/25/2019

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Directions to “RINCON FAMILY SERVICES ” Practice Location

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