Provider Demographics
NPI:1265705990
Name:FAMILY SERVICE AND MENTAL HEALTH CENTER OF CICERO
Entity type:Organization
Organization Name:FAMILY SERVICE AND MENTAL HEALTH CENTER OF CICERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-656-6430
Mailing Address - Street 1:5341 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2817
Mailing Address - Country:US
Mailing Address - Phone:708-656-6430
Mailing Address - Fax:708-656-6591
Practice Address - Street 1:320 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2612
Practice Address - Country:US
Practice Address - Phone:708-848-0528
Practice Address - Fax:708-848-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251V00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617631OtherBLUE CROSS BLUE SHIELD OF IL
IL1617631OtherBLUE CROSS BLUE SHIELD OF IL