Provider Demographics
NPI:1821565060
Name:ERIE FAMILY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:ERIE FAMILY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-432-2678
Mailing Address - Street 1:1701 W SUPERIOR ST FL 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5646
Mailing Address - Country:US
Mailing Address - Phone:312-432-2678
Mailing Address - Fax:312-666-0610
Practice Address - Street 1:1701 W SUPERIOR ST FL 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5646
Practice Address - Country:US
Practice Address - Phone:312-432-2678
Practice Address - Fax:312-666-0610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIE FAMILY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid