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NPI Code Detail

MEDICARE: PCC COMMUNITY WELLNESS CENTER

MEDICARE: PCC COMMUNITY WELLNESS 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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1871516799
Entity Type Code : Organization
Provider Name (Legal Business Name) : PCC COMMUNITY WELLNESS CENTER
Provider Business Mailing Address
First Line : 14 LAKE ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-2606
Country : US
Telephone Number : 708-383-0113
Fax Number : 708-383-1378
Provider Business Practice Location Address
First Line : 14 LAKE ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-2606
Country : US
Telephone Number : 708-383-0113
Fax Number : 708-383-1378
Authorized Official
Title or Position : PRESIDENT CEO
Name : ROBERT J URSO
Credential :
Telephone Number : 708-383-9786
Provider Enumeration Date : 07/25/2006
Last Update Date : 08/22/2020

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Directions to “PCC COMMUNITY WELLNESS CENTER ” Practice Location

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