MEDICARE: CHICAGO HOUSE AND SOCIAL SERVICE AGENCY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912459942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO HOUSE AND SOCIAL SERVICE AGENCY

Provider Business Mailing Address
First Line	:	2229 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2102
Country	:	US
Telephone Number	:	773-232-1370
Fax Number	:

Provider Business Practice Location Address
First Line	:	2229 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2102
Country	:	US
Telephone Number	:	773-232-1370
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	TERRI WILKERSON
Credential	:
Telephone Number	:	773-232-1370

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	12/03/2025

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