Provider Demographics
NPI:1487416871
Name:WILL COUNTY COMMUNITY HEALTH CENTER AT WILL COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:WILL COUNTY COMMUNITY HEALTH CENTER AT WILL COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-774-7323
Mailing Address - Street 1:1106 NEAL AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-2548
Mailing Address - Country:US
Mailing Address - Phone:815-727-8670
Mailing Address - Fax:815-849-8932
Practice Address - Street 1:501 ELLA AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-2799
Practice Address - Country:US
Practice Address - Phone:815-727-5961
Practice Address - Fax:815-849-8932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILL COUNTY COMMUNITY HEALTH CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)