| Center On Halsted | |
|
3656 N Halsted St Chicago IL 60613-4316 | |
| (773) 472-6469 | |
| (773) 472-6643 |
| Full Name | Center On Halsted |
|---|---|
| Speciality | Clinic/Center |
| Location | 3656 N Halsted St, Chicago, Illinois |
| Authorized Official Name and Position | Modesto Valle (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7734726469 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center On Halsted 3656 N Halsted St Chicago IL 60613-4316 Ph: (773) 472-6469 | Center On Halsted 3656 N Halsted St Chicago IL 60613-4316 Ph: (773) 472-6469 |
| NPI Number | 1508824244 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 10/21/2015 |
| Medicare PECOS PAC ID | 0042250805 |
|---|---|
| Medicare Enrollment ID | O20050511000361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508824244 | NPI | - | NPPES |
| 01634461 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ing Swenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063680650 PECOS PAC ID: 8628152600 Enrollment ID: I20150617002413 |
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