Provider Demographics
NPI:1093858151
Name:IDHS CHICAGO READ MHC
Entity Type:Organization
Organization Name:IDHS CHICAGO READ MHC
Other - Org Name:4564 UNIT B-SOUTH
Other - Org Type:Other Name
Authorized Official - Title/Position:RO1
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-794-3733
Mailing Address - Street 1:4200 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1417
Mailing Address - Country:US
Mailing Address - Phone:773-794-3733
Mailing Address - Fax:773-794-4046
Practice Address - Street 1:4200 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1417
Practice Address - Country:US
Practice Address - Phone:773-794-3733
Practice Address - Fax:773-794-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL144010Medicare ID - Type Unspecified