| NPI | 1770661019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA THOMPSON CEO 773-257-6770 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-08-10 |