Organization
PILSEN LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANCISCO CISNEROS MA (EXECUTIVE DIRECTOR)
(773) 579-0832
Entity
Organization
Contact information
Practice address
2316 S DAMEN AVE, CHICAGO, IL 60608-4210
(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
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70193
MEDICARE
IL
05
—
ILSP003599
—
IL
Enumeration date
01/15/2008
Last updated
04/09/2021
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