Organization
PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANCISCO CISNEROS MA, CADC (EXECUTIVE DIRECTOR)
(773) 579-0832
Entity
Organization
Contact information
Practice address
2319 S DAMEN AVE, CHICAGO, IL 60608-4209
(773) 579-0832
(773) 579-0762
Mailing address
2319 S DAMEN AVE, CHICAGO, IL 60608-4209
(773) 579-0832
(773) 579-0762
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A-0155-0001-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-0155-0001-A
STATE CONTRACTS
IL
05
—
A-0155-0001-A
—
IL
Enumeration date
02/14/2008
Last updated
02/14/2008
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