Provider Demographics
NPI:1780859447
Name:ADA S MCKINLEY COMMUNITY SVCS
Entity type:Organization
Organization Name:ADA S MCKINLEY COMMUNITY SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:312-385-2000
Mailing Address - Street 1:725 S WELLS ST
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4521
Mailing Address - Country:US
Mailing Address - Phone:312-385-2000
Mailing Address - Fax:
Practice Address - Street 1:2659 W 59TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1541
Practice Address - Country:US
Practice Address - Phone:773-434-5577
Practice Address - Fax:773-434-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========016Medicaid