Provider Demographics
NPI:1841304219
Name:ADA S. MCKINLEY COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:ADA S. MCKINLEY COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-385-2000
Mailing Address - Street 1:1359 W. WASHINGTON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1905
Mailing Address - Country:US
Mailing Address - Phone:312-385-2000
Mailing Address - Fax:312-554-8161
Practice Address - Street 1:2715 W. 63RD STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2305
Practice Address - Country:US
Practice Address - Phone:773-918-6100
Practice Address - Fax:773-434-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2024-01-12
Deactivation Date:2021-03-26
Deactivation Code:
Reactivation Date:2021-06-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid
IL=========002Medicaid
IL=========003Medicaid
IL=========001Medicaid
IL=========005Medicaid