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Organization
NEAR NORTH HEALTH SERVICE CORPORATION
Active
Organization
NEAR NORTH HEALTH SERVICE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA DENISE SMITH (PATIENT REVENUE MANAGER)
(312) 337-1073
Entity
Organization
Contact information
Practice address
1276 N CLYBOURN AVE, CHICAGO, IL 60610-2003
(331) 643-5238
Mailing address
1276 N CLYBOURN AVE, CHICAGO, IL 60610-2003
(331) 643-5238
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
NULL
251J00000X
Nursing Care Agency
—
NULL
251K00000X
Public Health or Welfare Agency
Primary
—
NULL
261Q00000X
Clinic/Center
—
NULL
261QF0400X
Federally Qualified Health Center (FQHC)
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
261QR1300X
Rural Health Clinic/Center
—
NULL
Other
Enumeration date
08/23/2022
Last updated
08/23/2022
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