Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
UIC-MSHC Hope Academy Health and Wellness CTR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY TAYLOR (EXECUTIVE DIRECTOR)
(312) 413-1261
Entity
Organization
Contact information
Practice address
1628 W WASHINGTON BLVD, CHICAGO, IL 60612-2613
(312) 226-3288
(312) 226-3541
Mailing address
2045 W WASHINGTON BLVD, CHICAGO, IL 60612-2428
(312) 413-9854
(312) 413-7812
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BCBC PROVIDER
IL
Enumeration date
10/22/2010
Last updated
12/10/2015
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