Organization
CIRCLE FAMILY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REUBEN PETTIFORD (CEO)
(773) 379-1000
Entity
Organization
Contact information
Practice address
4909 W DIVISION ST, SUITE 307, CHICAGO, IL 60651-3161
(773) 921-8100
(773) 921-2530
Mailing address
5002 W MADISON ST, CHICAGO, IL 60644-4127
(773) 379-1000
(773) 379-1342
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/20/2006
Last updated
08/22/2020
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