Provider Demographics
NPI:1659781029
Name:PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC
Other - Org Name:PILSEN WELLNESS CENTER INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-579-0832
Mailing Address - Street 1:2319 S DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4209
Mailing Address - Country:US
Mailing Address - Phone:773-579-0832
Mailing Address - Fax:773-579-0762
Practice Address - Street 1:2230 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2522
Practice Address - Country:US
Practice Address - Phone:773-579-0832
Practice Address - Fax:773-579-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health