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Organization
PILSEN LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Active
Organization
PILSEN LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANCISCO CISNEROS MA (EXECUTIVE DIRECTOR)
(773) 579-0832
Entity
Organization
Contact information
Practice address
2316 S DAMEN AVE, CHICAGO, IL 60608-4210
(773) 579-0832
(773) 579-0762
Mailing address
2319 S DAMEN AVE, CHICAGO, IL 60608-4209
(773) 579-0832
(773) 579-0762
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70193
MEDICARE
IL
05
—
ILSP003599
—
IL
Enumeration date
01/15/2008
Last updated
04/09/2021
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