Organization
HUMBOLDT PARK HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOROTHY CHERYL ERINS (CREDENTIALING SPECIALIST)
(269) 244-5256
Entity
Organization
Contact information
Practice address
1044 N FRANCISCO AVE, CHICAGO, IL 60622
(773) 292-8200
(773) 278-3899
Mailing address
1044 N FRANCISCO AVE, CHICAGO, IL 60622-2743
(773) 292-8200
(773) 278-3899
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
0001727
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14S206
MEDICARE PROVIDER NUMBER
IL
Enumeration date
06/28/2006
Last updated
01/27/2021
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