Organization
CHICAGO YOUTH CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. J. HARRY WELLS (PRESIDENT/CEO)
(312) 795-3500
Entity
Organization
Contact information
Practice address
461 E 111TH ST, CHICAGO, IL 60628-4558
(773) 468-4660
Mailing address
104 S MICHIGAN AVE STE 1400, CHICAGO, IL 60603-5916
(312) 795-3500
(312) 795-3520
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
00418812
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08001
MEDICAID CERTIFICATION
IL
Enumeration date
02/05/2009
Last updated
02/05/2009
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