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Organization

COMMUNITY HEALTH INTERGRATED COPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN DAVID WALLACE PSY.D (CEO)
(702) 793-5775
Entity
Organization

Contact information

Practice address
111 W JACKSON BLVD, 1700, CHICAGO, IL 60604-3589
(702) 793-5775
Mailing address
111 W JACKSON BLVD, 1700, CHICAGO, IL 60604-3589
(702) 793-5775

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
04/28/2015
Last updated
04/28/2015
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