Provider Demographics
NPI:1437324100
Name:ADA S MCKINLEY COMMUNITY SVCS
Entity Type:Organization
Organization Name:ADA S MCKINLEY COMMUNITY SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIR QA&C
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-469-2046
Mailing Address - Street 1:1359 W. WASHINGTON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1905
Mailing Address - Country:US
Mailing Address - Phone:312-385-2000
Mailing Address - Fax:
Practice Address - Street 1:8741 S GREENWOOD AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7061
Practice Address - Country:US
Practice Address - Phone:773-918-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========017Medicaid