Provider Demographics
NPI:1023393485
Name:CITY OF CHICAGO: GREATER LAWN COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:CITY OF CHICAGO: GREATER LAWN COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-747-1020
Mailing Address - Street 1:4150 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4242
Mailing Address - Country:US
Mailing Address - Phone:312-747-1020
Mailing Address - Fax:
Practice Address - Street 1:4150 W 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4242
Practice Address - Country:US
Practice Address - Phone:312-747-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health