Provider Demographics
NPI:1770818064
Name:MIDWEST FAMILY AND COMMUNITY RESOURCES PC
Entity Type:Organization
Organization Name:MIDWEST FAMILY AND COMMUNITY RESOURCES PC
Other - Org Name:MFCR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRERSIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:708-745-3040
Mailing Address - Street 1:3330 W 177TH ST
Mailing Address - Street 2:SUITE 1-F
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2184
Mailing Address - Country:US
Mailing Address - Phone:708-745-3040
Mailing Address - Fax:708-799-1889
Practice Address - Street 1:3330 W 177TH ST
Practice Address - Street 2:SUITE 1-F
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2184
Practice Address - Country:US
Practice Address - Phone:708-745-3040
Practice Address - Fax:708-799-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149007763251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health