PCC COMMUNITY WELLNESS CENTER (NPI# 1760630750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760630750 |
| Entity Type | Organization |
| Organization Name | PCC COMMUNITY WELLNESS CENTER |
| Other Organization Name | INTERFAITH HOUSE |
| Practice Address |
3456 W Franklin Blvd Chicago IL 60624-1308 |
| Practice Telephone | 7735333107 |
| Mailing Telephone | 7735333107 |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2008-09-03 |
| Authorized Official Name | ROBERT J URSO (PRESIDENT AND CEO) |
| Authorized Official Telephone | 7083839786 |
| Is Organization Subpart | Y |
| Parent Organization Name | PCC COMMUNITY WELLNESS CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
=========006 | IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Interfaith House | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114498540 | Pcc Community Wellness Center | Clinic/Center | 115 N Parkside Ave Fl 1, Chicago, IL 60644-3040 | 2018-12-11 |
| 1508287673 | Pcc Community Wellness Center | Clinic/Center | 1 Erie Ct Ste 7140, Oak Park, IL 60302-2510 | 2013-12-17 |
| 1487670097 | Pcc Community Wellness Center | Clinic/Center | 5359 E Fullerton Ave, Chicago, IL 60639-1450 | 2006-07-15 |
| 1295385490 | Pcc Community Wellness Center | Clinic/Center | 4534 S Western Ave, Chicago, IL 60609-3027 | 2019-09-19 |
| 1689158271 | Pcc Community Wellness Center | Case Management | 14 Lake St, Oak Park, IL 60302-2606 | 2018-09-19 |
| 1255701942 | Pcc Community Wellness Center | Clinic/Center | 3030 N Mobile Ave, Chicago, IL 60634-4041 | 2015-10-07 |
| 1548671563 | Pcc Community Wellness Center | Clinic/Center | 6201 Roosevelt Rd, Berwyn, IL 60402-1108 | 2014-05-13 |
| 1750621769 | Pcc Community Wellness Center | Clinic/Center | 3 Erie Ct, Suite 1300, Oak Park, IL 60302-2519 | 2013-02-28 |
| 1427365311 | Pcc Community Wellness Center | Clinic/Center | 120 S Marion St, Oak Park, IL 60302-2809 | 2010-09-13 |
| 1962633081 | Pcc Community Wellness Center | Clinic/Center | 1044 N Francisco Ave, Chicago, IL 60622-2743 | 2009-08-06 |
| Street Address |
3456 W FRANKLIN BLVD |
| City | CHICAGO |
| State | IL |
| Zip Code | 60624-1308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679793913 | Jerome Pietrusiak | Social Worker | 3456 W Franklin Blvd, Chicago, IL 60624-1308 | 2007-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669071932 | Euginia Ivanova | Counselor | 3410 W. Roosevelt Rd, Chicago, IL 60624 | 2020-10-19 |
| 1629619572 | Denise R Bean | Technician | 3322 West Polk St, Chicago, IL 60624 | 2019-10-02 |
| 1033693742 | Ahmed Hussain Memon | Nurse Practitioner | 3800 West Madison, Chicago, IL 60624 | 2018-09-18 |
| 1487104006 | Jeffrey Blythe | Social Worker | 3605 W. Fillmore Street, Ucan, Chicago, IL 60624 | 2016-10-06 |
| 1366992216 | Brian Macwilliams | Social Worker | 3605 W. Fillmore St, Chicago, IL 60624 | 2016-10-04 |
| 1982151510 | Darryl Lamont Clayton | Counselor | 3605 W. Fillmore, Chicago, IL 60624 | 2016-09-01 |
| 1821487646 | Total Enrichment Services Inc. | Counselor | 3335 W Washington Blvd, Chicago, IL 60624 | 2015-01-16 |
| 1295038818 | Raad N Rashan M D S C | Internal Medicine | 3743 W Chicago Ave, Chicago, IL 60624 | 2010-12-21 |
| 1194044453 | Theresa Roberts | Speech-Language Pathologist | 3240 W. Franklin Blvd, Chicago, IL 60624 | 2010-05-26 |
| 1154570208 | Ht Outpatient Pharmacy | Pharmacy | 3435 W Vanburen St, Chicago, IL 60624 | 2008-09-13 |
| Find all providers in zip 60624 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932724390 | Friend Family Health Center, Inc | Clinic/Center | 7355 S Jeffery Blvd, Chicago, IL 60649-3121 | 2020-06-11 |
| 1871117937 | Primecare Community Health Inc | Clinic/Center | 1431 N Western Ave Ste 101, Chicago, IL 60622-7712 | 2020-06-04 |
| 1407482219 | Access Community Health Network | Clinic/Center | 6020 W Diversey Ave Bldg West, Chicago, IL 60639-1108 | 2020-03-13 |
| 1427600345 | The Board of Trustees of The University of Illinois | Clinic/Center | 6835 S Normal Blvd, Chicago, IL 60621-2535 | 2019-07-11 |
| 1114498540 | Pcc Community Wellness Center | Clinic/Center | 115 N Parkside Ave Fl 1, Chicago, IL 60644-3040 | 2018-12-11 |
| 1427523125 | Howard Brown Health Center | Clinic/Center | 3533 W North Ave Ste 1, Chicago, IL 60647-7573 | 2018-10-09 |
| 1336626936 | Heartland International Health Center | Clinic/Center | 1631 W Jonquil Ter, Chicago, IL 60626-1103 | 2018-07-26 |
| 1760975304 | Inner-city Muslim Action Network | Clinic/Center | 2744 W 63rd St Bldg 2, Chicago, IL 60629-2343 | 2018-06-08 |
| 1417473851 | Howard Brown Health Center | Clinic/Center | 2800 N Sheridan Rd Ste 211, Chicago, IL 60657-6161 | 2017-08-17 |
| 1487193181 | Mile Square Englewood/cook Satellite Health and Wellness Center | Clinic/Center | 8150 S Bishop St, Chicago, IL 60620-3854 | 2017-02-15 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.