Organization
FAMILY SERVICE AND MENTAL HEALTH CENTER OF CICERO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORENA NAVARRETE (OFFICE MANAGER)
(708) 656-6430
Entity
Organization
Contact information
Practice address
320 LAKE ST, OAK PARK, IL 60302-2612
(708) 848-0528
(708) 848-5855
Mailing address
5341 W CERMAK RD, CICERO, IL 60804-2817
(708) 656-6430
(708) 656-6591
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
IL
251V00000X
Voluntary or Charitable Agency
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1617631
BLUE CROSS BLUE SHIELD OF IL
IL
Enumeration date
02/10/2012
Last updated
12/07/2017
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