| Esperanza At Cultivate Collective | |
|
4350 S Laport Ave Chicago IL 60638 | |
| (773) 584-6200 | |
| Not Available |
| Full Name | Esperanza At Cultivate Collective |
|---|---|
| Speciality | Clinic/Center |
| Location | 4350 S Laport Ave, Chicago, Illinois |
| Authorized Official Name and Position | Zachary Spreitzer (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 7736405785 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Esperanza At Cultivate Collective 1940 S Western Ave Ste 205 Chicago IL 60608-2503 Ph: () - | Esperanza At Cultivate Collective 4350 S Laport Ave Chicago IL 60638 Ph: (773) 584-6200 |
| NPI Number | 1265114623 |
|---|---|
| Provider Enumeration Date | 08/04/2023 |
| Last Update Date | 10/05/2023 |
| Medicare PECOS PAC ID | 2961453105 |
|---|---|
| Medicare Enrollment ID | O20231108002818 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265114623 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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