Organization
ERIE FAMILY HEALTH CENTER INC
Active
Other names
Erie Waukegan 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
2323 GRAND AVE, 2323 GRAND AVENUE, WAUKEGAN, IL 60085-3312
(312) 666-3494
(312) 666-0610
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616827
BLUE CROSS BLUE SHIELDS
IL
Enumeration date
12/16/2013
Last updated
12/16/2013
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