Organization
FRIEND FAMILY HEALTH CENTER INC
Active
Parent organization
FRIEND FAMILY HEALTH CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRIEND FAMILY HEALTH CENTER
Authorized official
ANGEL MCREYNOLDS (BILLING/PROVIDER SERVICES MGR)
(773) 705-2260
Entity
Organization
Contact information
Practice address
4802 S ASHLAND AVE, CHICAGO, IL 60609-4233
(773) 376-9400
Mailing address
2436 W 47TH ST, CHICAGO, IL 60632-1336
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141163
MEDICARE PTAN
IL
Enumeration date
06/08/2009
Last updated
08/06/2013
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