Provider Demographics
NPI:1134954506
Name:PCC COMMUNITY WELLNESS CENTER
Entity type:Organization
Organization Name:PCC COMMUNITY WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIANGHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-524-7686
Mailing Address - Street 1:5425 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-2342
Mailing Address - Country:US
Mailing Address - Phone:708-406-3927
Mailing Address - Fax:
Practice Address - Street 1:5425 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2342
Practice Address - Country:US
Practice Address - Phone:773-413-1920
Practice Address - Fax:773-413-1922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PCC COMMUNITY WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-05
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)