Provider Demographics
NPI:1376362715
Name:UNIVERSAL FAMILY CONNECTION
Entity type:Organization
Organization Name:UNIVERSAL FAMILY CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CADC
Authorized Official - Phone:773-818-1711
Mailing Address - Street 1:1350 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2302
Mailing Address - Country:US
Mailing Address - Phone:773-881-1711
Mailing Address - Fax:773-881-3379
Practice Address - Street 1:1350 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2302
Practice Address - Country:US
Practice Address - Phone:773-881-1711
Practice Address - Fax:773-881-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health