Provider Demographics
NPI:1326226077
Name:POLISH AMERICAN ASSOCIATION
Entity Type:Organization
Organization Name:POLISH AMERICAN ASSOCIATION
Other - Org Name:POLISH WELFARE ASSOCIATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KINGA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KOSMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-427-6304
Mailing Address - Street 1:3834 N CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3622
Mailing Address - Country:US
Mailing Address - Phone:773-282-8206
Mailing Address - Fax:773-282-1324
Practice Address - Street 1:3834 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3622
Practice Address - Country:US
Practice Address - Phone:773-282-8206
Practice Address - Fax:773-282-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA08000001A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health