Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
Integrated Health Care - AVIVA
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH M RALEIGH (DIRECTOR)
(312) 996-7663
Entity
Organization
Contact information
Practice address
3240 W DIVISION ST, CHICAGO, IL 60651-2405
(312) 413-7425
(312) 996-3512
Mailing address
845 S DAMEN AVE, M/C 802, CHICAGO, IL 60612-3727
(312) 996-7663
(312) 996-3512
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BCBS
IL
Enumeration date
02/13/2014
Last updated
01/22/2016
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