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Organization
LIFESCORE FOUNDATION
Active
Organization
LIFESCORE FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEYONCA JOHNSON (PRESIDENT)
(773) 251-1221
Entity
Organization
Contact information
Practice address
8244 S COTTAGE GROVE AVE, CHICAGO, IL 60619-5302
(773) 251-1221
Mailing address
8244 S COTTAGE GROVE AVE, CHICAGO, IL 60619-5302
(773) 251-1221
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
261QC1500X
Community Health Clinic/Center
Primary
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
261QI0500X
Infusion Therapy Clinic/Center
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
261QM1000X
Migrant Health Clinic/Center
—
NULL
261QP2400X
Prison Health Clinic/Center
—
NULL
343900000X
Non-emergency Medical Transport (VAN)
—
NULL
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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