Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
UIC-MSHC College Prep Health and Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT TAYLOR (CFO)
(312) 413-1789
Entity
Organization
Contact information
Practice address
1231 S DAMEN AVE, CHICAGO, IL 60608-1145
(312) 243-3741
(312) 243-0754
Mailing address
2045 W WASHINGTON BLVD, CHICAGO, IL 60612-2428
(312) 413-1789
(312) 413-7812
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BCBC PROVIDER
IL
Enumeration date
06/19/2009
Last updated
06/22/2009
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