Provider Demographics
NPI:1801304142
Name:PROVISO PUBLIC PARTNERSHIP
Entity type:Organization
Organization Name:PROVISO PUBLIC PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-240-4435
Mailing Address - Street 1:4565 HARRISON ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-1617
Mailing Address - Country:US
Mailing Address - Phone:708-240-4435
Mailing Address - Fax:708-449-6421
Practice Address - Street 1:4565 HARRISON ST FL 3
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1617
Practice Address - Country:US
Practice Address - Phone:708-240-4435
Practice Address - Fax:708-449-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)