| Advanced Clinical Health Service Corporation | |
|
2925 S Wabash Ave Ste 102 Chicago IL 60616-3583 | |
| (773) 879-2274 | |
| (312) 225-6742 |
| Full Name | Advanced Clinical Health Service Corporation |
|---|---|
| Speciality | Social Worker |
| Location | 2925 S Wabash Ave Ste 102, Chicago, Illinois |
| Authorized Official Name and Position | Edrena Joy Davis (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 7738792274 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Clinical Health Service Corporation 2925 S Wabash Ave Ste 102 Chicago IL 60616-3583 Ph: (773) 879-2274 | Advanced Clinical Health Service Corporation 2925 S Wabash Ave Ste 102 Chicago IL 60616-3583 Ph: (773) 879-2274 |
| NPI Number | 1891200317 |
|---|---|
| Provider Enumeration Date | 12/06/2017 |
| Last Update Date | 12/06/2017 |
| Medicare PECOS PAC ID | 1052670320 |
|---|---|
| Medicare Enrollment ID | O20180111001975 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891200317 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149018258 (Illinois) | Primary |
| Provider Name | Edrena Joy Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619313889 PECOS PAC ID: 1658666110 Enrollment ID: I20160823000824 |
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