| Gro Community | |
|
259 E 115th St Chicago IL 60628-5014 | |
| (618) 203-4368 | |
| Not Available |
| Full Name | Gro Community |
|---|---|
| Speciality | Clinic/Center |
| Location | 259 E 115th St, Chicago, Illinois |
| Authorized Official Name and Position | Aaron Mallory (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7732538385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gro Community 259 E 115th St Chicago IL 60628-5014 Ph: (618) 203-4368 | Gro Community 259 E 115th St Chicago IL 60628-5014 Ph: (618) 203-4368 |
| NPI Number | 1013414150 |
|---|---|
| Provider Enumeration Date | 04/06/2018 |
| Last Update Date | 12/12/2023 |
| Medicare PECOS PAC ID | 2163835158 |
|---|---|
| Medicare Enrollment ID | O20210112002831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013414150 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (Illinois) | Primary |
| Provider Name | Aaron Mallory |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114423449 PECOS PAC ID: 3072926062 Enrollment ID: I20210112002896 |
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