Provider Demographics
NPI:1326031998
Name:CIRCLE FAMILY HEALTHCARE NETWORK INC
Entity Type:Organization
Organization Name:CIRCLE FAMILY HEALTHCARE NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-379-1000
Mailing Address - Street 1:5002 W MADISON ST
Mailing Address - Street 2:CIRCLE FAMILY HEALTHCARE NETWORK INC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4127
Mailing Address - Country:US
Mailing Address - Phone:773-379-1000
Mailing Address - Fax:773-379-1342
Practice Address - Street 1:115 N PARKSIDE AVE
Practice Address - Street 2:CIRCLE FAMILY HEALTHCARE NETWORK INC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-3040
Practice Address - Country:US
Practice Address - Phone:773-379-1000
Practice Address - Fax:773-379-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========010Medicaid
IL=========010Medicaid
797650Medicare ID - Type Unspecified