Organization
ERIE FAMILY HEALTH CENTER INC
Active
Organization
ERIE FAMILY HEALTH CENTER INC
Active
Other names
Erie Health Reach Mundelein Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GABRIELA NORENA (BILLING MANAGER)
(312) 432-7444
Entity
Organization
Contact information
Practice address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
(312) 666-0610
Mailing address
109 N SEYMOUR AVE, MUNDELEIN, IL 60060-2318
(312) 666-3494
(312) 666-0610
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616827
B/C B/S
IL
01
—
748480
MEDICARE PART B
IL
Enumeration date
03/26/2014
Last updated
03/26/2014
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