Provider Demographics
NPI:1700135266
Name:FAMILY SERVICE & MHC OF CICERO AT CICERO HEALTH DEPT
Entity Type:Organization
Organization Name:FAMILY SERVICE & MHC OF CICERO AT CICERO HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-656-6430
Mailing Address - Street 1:5341 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2817
Mailing Address - Country:US
Mailing Address - Phone:708-656-6430
Mailing Address - Fax:708-656-6591
Practice Address - Street 1:2250 S 49TH AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2460
Practice Address - Country:US
Practice Address - Phone:708-656-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SERVICE AND MENTAL HEALTH CENTER OF CICERO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-30
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202591Medicare PIN