CHICAGO FAMILY HEALTH CENTER, INC. (NPI# 1063614923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063614923 |
| Entity Type | Organization |
| Organization Name | CHICAGO FAMILY HEALTH CENTER, INC. |
| Other Organization Name | CHICAGO FAMILY HEALTH CENTER |
| Practice Address |
570 E 115th St Chicago IL 60628-5740 |
| Mailing Address |
9119 S Exchange Ave Chicago IL 60617-4225 |
| Practice Telephone | 7737685000 |
| Practice Fax Number | 7738403409 |
| Mailing Telephone | 7737685000 |
| Mailing Fax Number | 7737686153 |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2016-09-21 |
| Authorized Official Name | MR. JOSEPH ERIC BOKLAGE (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Telephone | 7737685000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | CITY LICENSE | 7991 | 01 |
| IL | CLIA CERTIFICATE | 14D0696915 | 01 |
| IL | CONTROL SUBSTANCE LICENSE | 097001196 | 01 |
| Other Name | Type Code |
|---|---|
| Chicago Family Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154684736 | Chicago Family Health Center, Inc. | Clinic/Center | 2938 E 89th St, Chicago, IL 60617-3244 | 2012-06-19 |
| 1629388756 | Chicago Family Health Center, Inc. | Clinic/Center | 3223 W. 63rd St., Chicago, IL 60629 | 2010-10-07 |
| 1770785644 | Chicago Family Health Center, Inc. | Clinic/Center | 120 W. 111th St., Chicago, IL 60628 | 2007-06-04 |
| 1245266337 | Chicago Family Health Center, Inc. | Clinic/Center | 9119 S. Exchange Ave., Chicago, IL 60617 | 2006-06-23 |
| 1730436452 | Chicago Family Health Center, Inc. | Clinic/Center | 3963 W Belmont Ave, 242, Chicago, IL 60618-5149 | 2012-08-13 |
| 1386942274 | Chicago Family Health Center, Inc. | Case Management | 9119 S Exchange Ave, Chicago, IL 60617-4225 | 2011-03-02 |
| 1992976419 | Chicago Family Health Center, Inc. | Clinic/Center | 10536 S Ewing Ave, Chicago, IL 60617-6219 | 2008-03-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CHICAGO FAMILY HEALTH CENTER, INC. | 9119 S Exchange Ave, Chicago, IL 60617-4225 |
| Street Address |
570 E 115TH ST |
| City | CHICAGO |
| State | IL |
| Zip Code | 60628-5740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578189577 | Sommer Mckinney | Nurse Practitioner | 570 E 115th St, Chicago, IL 60628-5740 | 2020-06-25 |
| 1801334008 | Ariel Bernstein | Social Worker | 570 E 115th St, Chicago, IL 60628-5740 | 2017-02-08 |
| 1396296299 | Julia Gordon | Nurse Practitioner | 570 E 115th St, Chicago, IL 60628-5740 | 2016-10-17 |
| 1164972055 | Kimberly Scott | Nurse Practitioner | 570 E 115th St, Chicago, IL 60628-5740 | 2016-10-04 |
| 1992170393 | Sharmaine Patterson | Nurse Practitioner | 570 E 115th St, Chicago, IL 60628-5740 | 2015-12-10 |
| 1023496767 | Laura Michelle Douglas | Dentist | 570 E 115th St, Chicago, IL 60628-5740 | 2015-05-14 |
| 1326440538 | Katrina Mosley | Dentist | 570 E 115th St, Chicago, IL 60628-5740 | 2014-09-18 |
| 1720242852 | Ophelia K. Carlton | Dentist | 570 E 115th St, Chicago, IL 60628-5740 | 2008-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750857942 | Myrna Pledger | Counselor | 259 W. 104th Pl., Chicago, IL 60628 | 2018-10-16 |
| 1073097184 | 4every1 Lab Inc. | Clinical Medical Laboratory | 10723 S Halsted St, Chicago, IL 60628 | 2018-09-24 |
| 1922594613 | Northwest Adult Wellness Center LLC | Clinic/Center | 235 W 95th Suite 3, Chicago, IL 60628 | 2018-07-05 |
| 1285152801 | Brittany Bellamy | Developmental Therapist | 10333 S Prairie, Chicago, IL 60628 | 2017-09-04 |
| 1598293839 | Denise Marie Mercherson | Social Worker | 9561 S. Union, Chicago, IL 60628 | 2017-05-31 |
| 1659821221 | Tca Health Care | Dentist | 1030 E. 130th St, Chicago, IL 60628 | 2016-10-07 |
| 1528432697 | Global Dialysis, LLC | Registered Nurse | 9746 South Harvard Ave., Chicago, IL 60628 | 2015-11-30 |
| 1871966382 | Kirby Rehabilitation, Inc | Clinic/Center | 723 W. 111th St, Chicago, IL 60628 | 2015-11-05 |
| 1851638605 | Marketa Marvanova | Pharmacist | 9501 S. King Drive, Douglas Hall 203-23, Chicago State University College of Pharmacy, Chicago, IL 60628 | 2013-01-14 |
| 1841567377 | Emma Goodman | Pharmacist | 10620 S. Halsted St, Chicago, IL 60628 | 2011-11-29 |
| Find all providers in zip 60628 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1427600345 | The Board of Trustees of The University of Illinois | Clinic/Center | 6835 S Normal Blvd, Chicago, IL 60621-2535 | 2019-07-11 |
| 1114498540 | Pcc Community Wellness Center | Clinic/Center | 115 N Parkside Ave Fl 1, Chicago, IL 60644-3040 | 2018-12-11 |
| 1427523125 | Howard Brown Health Center | Clinic/Center | 3533 W North Ave Ste 1, Chicago, IL 60647-7573 | 2018-10-09 |
| 1336626936 | Heartland International Health Center | Clinic/Center | 1631 W Jonquil Ter, Chicago, IL 60626-1103 | 2018-07-26 |
| 1760975304 | Inner-city Muslim Action Network | Clinic/Center | 2744 W 63rd St Bldg 2, Chicago, IL 60629-2343 | 2018-06-08 |
| 1417473851 | Howard Brown Health Center | Clinic/Center | 2800 N Sheridan Rd Ste 211, Chicago, IL 60657-6161 | 2017-08-17 |
| 1487193181 | Mile Square Englewood/cook Satellite Health and Wellness Center | Clinic/Center | 8150 S Bishop St, Chicago, IL 60620-3854 | 2017-02-15 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.