| NPI | 1144528167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGIE NEDA JOHNSON Executive Director 773-651-3828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: IL 036113305) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2017-08-24 |