Provider Demographics
NPI:1639653314
Name:PRIMO CENTER FOR WOMEN AND CHILDREN
Entity Type:Organization
Organization Name:PRIMO CENTER FOR WOMEN AND CHILDREN
Other - Org Name:PRIMO CENTER FOR WOMEN AND CHILDREN IHH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BILLING/MANAGE CARE STR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-826-7991
Mailing Address - Street 1:6212 S SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-2006
Mailing Address - Country:US
Mailing Address - Phone:773-826-7991
Mailing Address - Fax:773-471-6099
Practice Address - Street 1:6212 S SANGAMON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2006
Practice Address - Country:US
Practice Address - Phone:773-826-7991
Practice Address - Fax:773-471-6099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMO CENTER FOR WOMEN AND CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-19
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid