Organization
UCAN
Active
Other names
Uhlich Childrens Advantage Network
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN STACY (EXECUTIVE ASSISTANT)
(773) 588-0180
Entity
Organization
Contact information
Practice address
3640 W FILLMORE ST, CHICAGO, IL 60624-4309
(773) 588-0180
Mailing address
3605 W FILLMORE ST, CHICAGO, IL 60624-4310
(773) 588-0180
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2B05CHR011
—
IL
Enumeration date
05/25/2016
Last updated
12/22/2016
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