Provider Demographics
NPI:1114338290
Name:CHINESE MUTUAL AID ASSOCIATION
Entity Type:Organization
Organization Name:CHINESE MUTUAL AID ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF ELDERLY CARE & SOCIAL SERVIC
Authorized Official - Prefix:MS
Authorized Official - First Name:DARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-784-2900
Mailing Address - Street 1:1016 WEST ARGYLE STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:872-302-4240
Mailing Address - Fax:773-784-2984
Practice Address - Street 1:1016 WEST ARGYLE STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:872-302-4240
Practice Address - Fax:773-784-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL253Z00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-003Medicaid