# NEAR NORTH HEALTH SERVICE CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033838214
- **Authorized official:** WANDA DENISE SMITH (PATIENT REVENUE MANAGER)
- **Authorized official phone:** (312) 337-1073

## Contact information

- **Practice address:** 1276 N CLYBOURN AVE, CHICAGO, IL 60610-2003
- **Practice address phone:** (331) 643-5238
- **Mailing address:** 1276 N CLYBOURN AVE, CHICAGO, IL 60610-2003
- **Mailing address phone:** (331) 643-5238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174200000X | Meals Provider | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 251K00000X | Public Health or Welfare Agency | — | NULL | Yes |
| 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