Provider Demographics
NPI:1477175305
Name:FRIEND FAMILY HEALTH CENTER INC
Entity Type:Organization
Organization Name:FRIEND FAMILY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF PROVIDER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCREYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-795-2260
Mailing Address - Street 1:PO BOX 19351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-0266
Mailing Address - Country:US
Mailing Address - Phone:773-795-2260
Mailing Address - Fax:773-834-3756
Practice Address - Street 1:1140 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3029
Practice Address - Country:US
Practice Address - Phone:773-702-0660
Practice Address - Fax:773-834-3756
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIEND FAMILY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)