Provider Demographics
NPI:1629383443
Name:COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Entity type:Organization
Organization Name:COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MPH
Authorized Official - Phone:312-795-0000
Mailing Address - Street 1:205 W RANDOLPH ST
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1867
Mailing Address - Country:US
Mailing Address - Phone:312-795-0000
Mailing Address - Fax:312-795-0002
Practice Address - Street 1:1126 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-3564
Practice Address - Country:US
Practice Address - Phone:217-893-3052
Practice Address - Fax:217-893-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)