Provider Demographics
NPI:1346772373
Name:WILL COUNTY COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:WILL COUNTY COMMUNITY HEALTH CENTER
Other - Org Name:WILL COUNTY COMMUNITY HEALTH CENTER NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLENEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-740-8982
Mailing Address - Street 1:323 QUADRANGLE DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 QUADRANGLE DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3409
Practice Address - Country:US
Practice Address - Phone:630-679-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILL COUNTY COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-29
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
H80CS00476OtherHRSA GRANT NUMBER