Provider Demographics
NPI:1891921623
Name:FRIEND FAMILY HEALTH CENTER INC
Entity Type:Organization
Organization Name:FRIEND FAMILY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/PROVIDER SERVICES MGR
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCREYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-705-2260
Mailing Address - Street 1:2436 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4802 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-4233
Practice Address - Country:US
Practice Address - Phone:773-376-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIEND FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-08
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141163OtherMEDICARE PTAN
IL=========005Medicaid