Provider Demographics
NPI:1366817017
Name:ENGLEWOOD COMMUNITY CONNECTION OUTREACH
Entity Type:Organization
Organization Name:ENGLEWOOD COMMUNITY CONNECTION OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:FOUNDER
Authorized Official - Phone:773-885-2974
Mailing Address - Street 1:46 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2304
Mailing Address - Country:US
Mailing Address - Phone:773-885-2974
Mailing Address - Fax:
Practice Address - Street 1:7326 S EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3408
Practice Address - Country:US
Practice Address - Phone:773-885-2974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable