| NPI | 1740932532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDREY PENNINGTON Sr. Director Of Patient Access 773-802-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-01-22 |
| Last Update Date | 2022-01-22 |