Provider Demographics
NPI:1003232034
Name:RINCON FAMILY SERVICES
Entity Type:Organization
Organization Name:RINCON FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORRAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-564-9070
Mailing Address - Street 1:3942 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4639
Mailing Address - Country:US
Mailing Address - Phone:773-564-9070
Mailing Address - Fax:773-249-9362
Practice Address - Street 1:5453 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1413
Practice Address - Country:US
Practice Address - Phone:773-564-9070
Practice Address - Fax:773-249-9362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)