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
—
—
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Enumeration date
08/23/2022
Last updated
08/23/2022
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