Provider Demographics
NPI:1073155958
Name:CHICAGO HEALTH CLINIC NFP
Entity Type:Organization
Organization Name:CHICAGO HEALTH CLINIC NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:ATTY
Authorized Official - Phone:773-544-0201
Mailing Address - Street 1:6423 N ROCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5319
Mailing Address - Country:US
Mailing Address - Phone:773-544-0201
Mailing Address - Fax:
Practice Address - Street 1:6423 N ROCKWELL ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-5319
Practice Address - Country:US
Practice Address - Phone:773-544-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health