Provider Demographics
NPI:1649404716
Name:UCP SEGUIN OF GREATER CHICAGO
Entity Type:Organization
Organization Name:UCP SEGUIN OF GREATER CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-222-4248
Mailing Address - Street 1:3100 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-3956
Mailing Address - Country:US
Mailing Address - Phone:708-222-4248
Mailing Address - Fax:708-222-0478
Practice Address - Street 1:3100 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3956
Practice Address - Country:US
Practice Address - Phone:708-222-4248
Practice Address - Fax:708-222-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care