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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |