Provider Demographics
NPI:1588840045
Name:PILSEN LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:PILSEN LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:773-579-0832
Mailing Address - Street 1:2319 S DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4209
Mailing Address - Country:US
Mailing Address - Phone:773-579-0832
Mailing Address - Fax:773-579-0762
Practice Address - Street 1:2316 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4210
Practice Address - Country:US
Practice Address - Phone:773-579-0832
Practice Address - Fax:773-579-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2021-04-09
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
IL70193OtherMEDICARE
ILILSP003599Medicaid