Provider Demographics
NPI:1083020911
Name:PLANNED PARENTHOOD OF ILLINOIS
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF ILLINOIS
Other - Org Name:PLANNED PARENTHOOD CHICAGO AREA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-592-6892
Mailing Address - Street 1:17 N STATE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3384
Mailing Address - Country:US
Mailing Address - Phone:312-592-6800
Mailing Address - Fax:312-592-6801
Practice Address - Street 1:705 NE JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3843
Practice Address - Country:US
Practice Address - Phone:309-673-6911
Practice Address - Fax:309-673-6914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANNED PARENTHOOD OF ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36170901001Medicaid