| NPI | 1073536991 |
|---|---|
| Doing Business As | PCC LAKE STREET FAMILY HEALTH CENTER |
| Entity Type | Organization |
| Authorized Contact | ALYSSA N SIANGHIO President And CEO 708-383-9786 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: IL 001) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2026-01-09 |