Organization
PCC COMMUNITY WELLNESS CENTER
Active
Organization
PCC COMMUNITY WELLNESS CENTER
Active
Parent organization
PCC COMMUNITY WELLNESS CENTER
Other names
PCC Austin Family Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PCC COMMUNITY WELLNESS CENTER
Authorized official
ALYSSA SIANGHIO (PRESIDENT CEO)
(708) 524-7686
Entity
Organization
Contact information
Practice address
5461 W LAKE ST, CHICAGO, IL 60644-2342
(773) 378-3347
(773) 378-4028
Mailing address
14 LAKE ST, OAK PARK, IL 60302-2606
(708) 406-3927
(708) 406-3919
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
002
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141889
MEDICARE PART A PROVIDER NUMBER
—
05
—
=========
—
IL
Enumeration date
07/15/2006
Last updated
01/10/2025
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