Organization
LAWNDALE CHRISTIAN HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIWANI COOPER (CREDENTIALING SPECIALIST)
(872) 588-3027
Entity
Organization
Contact information
Practice address
5122 S ARCHER AVE, CHICAGO, IL 60632-4508
(872) 522-3560
Mailing address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
209010903
IL
Other
Enumeration date
11/15/2013
Last updated
11/15/2013
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