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	251S00000X	Community/Behavioral Health Agency	00488	IL

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	:	1982150017
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	:	6926 N GLENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-3412
Country	:	US
Telephone Number	:	773-338-9999
Fax Number	:	773-338-9519

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

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	08/29/2016

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