Provider Demographics
NPI:1629246467
Name:DEPAUL FAMILY & COMMUNITY SERVICES
Entity Type:Organization
Organization Name:DEPAUL FAMILY & COMMUNITY SERVICES
Other - Org Name:DEPAUL UNIVERSITY COMMUNITY MENTAL HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIBORDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-325-7780
Mailing Address - Street 1:2156 W WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-8156
Mailing Address - Country:US
Mailing Address - Phone:773-477-5581
Mailing Address - Fax:
Practice Address - Street 1:2156 W WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-8156
Practice Address - Country:US
Practice Address - Phone:773-477-5581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)