Provider Demographics
NPI:1780862920
Name:AUSTIN SATELLITE SENIOR CENTER
Entity Type:Organization
Organization Name:AUSTIN SATELLITE SENIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-744-5770
Mailing Address - Street 1:5071 W CONGRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4809
Mailing Address - Country:US
Mailing Address - Phone:312-743-1538
Mailing Address - Fax:
Practice Address - Street 1:5071 W CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4809
Practice Address - Country:US
Practice Address - Phone:312-743-1538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICAGO DEPARTMENT OF SENIOR SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-08
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center