Provider Demographics
NPI:1710579842
Name:FEATHERFIST
Entity Type:Organization
Organization Name:FEATHERFIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANEWISHKI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:773-721-7088
Mailing Address - Street 1:2255 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3228
Mailing Address - Country:US
Mailing Address - Phone:773-721-7088
Mailing Address - Fax:
Practice Address - Street 1:2255 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3228
Practice Address - Country:US
Practice Address - Phone:773-721-7088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management