Organization
MILE SQUARE DAVIS/BRIGHTON PARK SATELLITE HEALTH AND WELLNESS CENTER
Active
Parent organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Authorized official
MR. HENRY TAYLOR (EXECUTIVE DIRECTOR)
(312) 412-1261
Entity
Organization
Contact information
Practice address
3825 S WASHTENAW AVE, CHICAGO, IL 60632-1633
(773) 376-5293
Mailing address
3825 S WASHTENAW AVE, CHICAGO, IL 60632-1633
(773) 376-5293
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
02/10/2017
Last updated
09/04/2019
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