Provider Demographics
NPI:1508994831
Name:CENTURY PHO, INC.
Entity Type:Organization
Organization Name:CENTURY PHO, INC.
Other - Org Name:HUMBOLDT PARK HEALTH PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-278-8685
Mailing Address - Street 1:1029 N. SACRAMENTO AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:773-278-8555
Mailing Address - Fax:773-278-7515
Practice Address - Street 1:1029 N SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2746
Practice Address - Country:US
Practice Address - Phone:773-278-8555
Practice Address - Fax:773-278-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty