Organization
YOUTH OUTREACH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICK VELASQUEZ MSW (EXECUTIVE DIRECTOR)
(773) 777-7112
Entity
Organization
Contact information
Practice address
6417 W IRVING PARK RD, CHICAGO, IL 60634-2437
(773) 777-7112
(773) 777-7611
Mailing address
2411 W CONGRESS PKWY, CHICAGO, IL 60612-3534
(773) 777-7112
(773) 777-7611
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
A-0534-0007-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-0534-0007-A
IL
Other
Enumeration date
05/01/2007
Last updated
10/17/2017
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