Provider Demographics
NPI:1922549294
Name:COMMUNITY TRIAGE CENTER
Entity Type:Organization
Organization Name:COMMUNITY TRIAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-864-4649
Mailing Address - Street 1:200 E 115TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-5015
Mailing Address - Country:US
Mailing Address - Phone:773-291-2500
Mailing Address - Fax:
Practice Address - Street 1:200 E 115TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-5015
Practice Address - Country:US
Practice Address - Phone:773-291-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK COUNTY HEALTH & HOSPITALS SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health