Provider Demographics
NPI:1790957884
Name:CITY OF EVANSTON
Entity Type:Organization
Organization Name:CITY OF EVANSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, COMMUNITY HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-328-2100
Mailing Address - Street 1:2100 RIDGE AVE
Mailing Address - Street 2:CHILDREN'S DENTAL CLINIC
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2716
Mailing Address - Country:US
Mailing Address - Phone:847-866-2953
Mailing Address - Fax:847-448-8134
Practice Address - Street 1:2100 RIDGE AVE
Practice Address - Street 2:CHILDREN'S DENTAL CLINIC
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2716
Practice Address - Country:US
Practice Address - Phone:847-866-2953
Practice Address - Fax:847-448-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local