Provider Demographics
NPI:1427224286
Name:THE COMPREHENSIVE KOREAN SELF-HELP COMMUNITY CENTER
Entity Type:Organization
Organization Name:THE COMPREHENSIVE KOREAN SELF-HELP COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOONG
Authorized Official - Middle Name:KYUN
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-545-8348
Mailing Address - Street 1:4934 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2813
Mailing Address - Country:US
Mailing Address - Phone:773-545-8348
Mailing Address - Fax:773-545-0054
Practice Address - Street 1:4934 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2813
Practice Address - Country:US
Practice Address - Phone:773-545-8348
Practice Address - Fax:773-545-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6063001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health