Provider Demographics
NPI:1497747026
Name:CHICAGO REACH FOUNDATION
Entity Type:Organization
Organization Name:CHICAGO REACH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/RN/MS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRICUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-252-8989
Mailing Address - Street 1:4501 W AUGUSTA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3302
Mailing Address - Country:US
Mailing Address - Phone:773-252-8989
Mailing Address - Fax:773-252-8995
Practice Address - Street 1:4501 W AUGUSTA BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3302
Practice Address - Country:US
Practice Address - Phone:773-252-8989
Practice Address - Fax:773-252-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty