Provider Demographics
NPI:1982150017
Name:RINCON FAMILY SERVICES
Entity Type:Organization
Organization Name:RINCON FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT&CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORRAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-564-9070
Mailing Address - Street 1:3710 N KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4504
Mailing Address - Country:US
Mailing Address - Phone:773-564-9070
Mailing Address - Fax:773-564-9197
Practice Address - Street 1:6926 N GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3412
Practice Address - Country:US
Practice Address - Phone:773-338-9999
Practice Address - Fax:773-338-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00488251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00488Medicaid