Provider Demographics
NPI:1801981501
Name:AMERICAN SOCIAL SERVICES OF UPTOWN ASSU
Entity type:Organization
Organization Name:AMERICAN SOCIAL SERVICES OF UPTOWN ASSU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TENGBEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-506-0676
Mailing Address - Street 1:PO BOX 25135
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-506-0676
Mailing Address - Fax:773-506-0676
Practice Address - Street 1:4554 N BROADWAY STREET
Practice Address - Street 2:SUITES 319 320
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-506-0673
Practice Address - Fax:773-506-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid