Organization
CHICAGO FAMILY HEALTH CENTER, INC.
Active
Organization
CHICAGO FAMILY HEALTH CENTER, INC.
Active
Other names
Chicago Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH ERIC BOKLAGE (CHIEF ADMINISTRATIVE OFFICER)
(773) 768-5000
Entity
Organization
Contact information
Practice address
120 W. 111TH ST., CHICAGO, IL 60628
(773) 768-5000
(773) 374-1621
Mailing address
9119 S EXCHANGE AVE, CHICAGO, IL 60617-4225
(773) 768-5000
(773) 768-6153
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D1053833
CLIA LICENSE
IL
01
—
1697382
CITY LICENSE
IL
Enumeration date
06/04/2007
Last updated
09/21/2016
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