Organization
RINCON FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDDY BORRAYO (EXECUTIVE DIRECTOR)
(773) 564-9070
Entity
Organization
Contact information
Practice address
3809 W GRAND AVE, CHICAGO, IL 60651-2004
(773) 276-0200
(773) 276-4226
Mailing address
3710 N KEDZIE AVE, CHICAGO, IL 60618-4504
(773) 564-9070
(773) 564-9197
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14003
—
IL
Enumeration date
06/13/2016
Last updated
06/26/2020
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