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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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