Provider Demographics
NPI:1073088001
Name:ADA S MCKINLEY COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:ADA S MCKINLEY COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR QA&C
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-744-9431
Mailing Address - Street 1:1359 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1905
Mailing Address - Country:US
Mailing Address - Phone:312-385-2000
Mailing Address - Fax:312-554-0292
Practice Address - Street 1:8741 S GREENWOOD AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7061
Practice Address - Country:US
Practice Address - Phone:773-780-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty