Provider Demographics
NPI:1366610206
Name:PORTAGE PARK SATELLITE SENIOR CENTER
Entity type:Organization
Organization Name:PORTAGE PARK SATELLITE SENIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:312-744-0890
Mailing Address - Street 1:4100 N LONG AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1346
Mailing Address - Country:US
Mailing Address - Phone:312-744-9022
Mailing Address - Fax:
Practice Address - Street 1:4100 N LONG AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1346
Practice Address - Country:US
Practice Address - Phone:312-744-9022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICAGO DEPARTMENT OF SENIOR SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center