| Ican Community Services Inc. Nfp | |
|
15475 S Park Ave Suite 109 South Holland IL 60473-1328 | |
| (708) 596-5680 | |
| Not Available |
| Full Name | Ican Community Services Inc. Nfp |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 15475 S Park Ave, South Holland, Illinois |
| Authorized Official Name and Position | Anthony Olujimi (PRESIDENT/CEO) |
| Authorized Official Contact | 7082978580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ican Community Services Inc. Nfp 15475 S Park Ave Suite 109 South Holland IL 60473-1328 Ph: (708) 596-5680 | Ican Community Services Inc. Nfp 15475 S Park Ave Suite 109 South Holland IL 60473-1328 Ph: (708) 596-5680 |
| NPI Number | 1063702330 |
|---|---|
| Provider Enumeration Date | 04/07/2011 |
| Last Update Date | 12/22/2017 |
| Medicare PECOS PAC ID | 7113315730 |
|---|---|
| Medicare Enrollment ID | O20211101000117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063702330 | NPI | - | NPPES |
| IL-10,172M | Other | IL | FDA NUMBER |
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