| NPI | 1699701383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE JACKSON Provider Enrollment Manager 312-526-2279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2026-01-16 |