Provider Demographics
NPI:1801067368
Name:FAMILY SERVICE & MENTAL HEALTH SERVICE OF CICERO
Entity type:Organization
Organization Name:FAMILY SERVICE & MENTAL HEALTH SERVICE OF CICERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-656-6430
Mailing Address - Street 1:5341 W CERMAK RD
Mailing Address - Street 2:201
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:
Practice Address - Street 1:5341 W CERMAK RD
Practice Address - Street 2:201
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2817
Practice Address - Country:US
Practice Address - Phone:708-656-6430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management