Provider Demographics
NPI:1710304480
Name:EXPANDED MENTAL HEALTH SERVICES OF CHICAGO NFP
Entity Type:Organization
Organization Name:EXPANDED MENTAL HEALTH SERVICES OF CHICAGO NFP
Other - Org Name:THE KEDZIE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-754-0577
Mailing Address - Street 1:4141 N KEDZIE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2477
Mailing Address - Country:US
Mailing Address - Phone:773-754-0577
Mailing Address - Fax:
Practice Address - Street 1:4141 N KEDZIE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2477
Practice Address - Country:US
Practice Address - Phone:773-754-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health