Organization
PCC COMMUNITY WELLNESS CENTER
Active
Parent organization
PCC COMMUNITY WELLNESS CENTER
Other names
South Family Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PCC COMMUNITY WELLNESS CENTER
Authorized official
ROBERT J URSO (PRESIDENT & CEO)
(708) 383-9786
Entity
Organization
Contact information
Practice address
6201 ROOSEVELT RD, BERWYN, IL 60402-1108
(708) 386-0845
(708) 386-8472
Mailing address
6201 ROOSEVELT RD, BERWYN, IL 60402-1108
(708) 386-0845
(708) 386-8472
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
005
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141031
MEDICARE PROVIDER ID
IL
Enumeration date
07/15/2006
Last updated
07/21/2022
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