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
1546 N MANNHEIM RD, STONE PARK, IL 60165-1117
(708) 410-0856
(708) 410-0884
Mailing address
2319 S DAMEN AVE, CHICAGO, IL 60608-4209
(773) 579-0832
(773) 579-0762
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-0155-0004-A
STATE GRANTS
IL
05
—
A-0155-0004-A
—
IL
Enumeration date
01/31/2008
Last updated
02/07/2022
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