MEDICARE: JENNIFER S. FALLICK CANCER SUPPORT CENTER

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)

General Provider Information

NPI Number	:	1760358600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER S. FALLICK CANCER SUPPORT CENTER

Provider Business Mailing Address
First Line	:	2028 ELM RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1707
Country	:	US
Telephone Number	:	708-798-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 ELM RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1707
Country	:	US
Telephone Number	:	708-798-9171
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KRISTEN LUNSFORD
Credential	:
Telephone Number	:	708-879-2941

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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