Provider Demographics
NPI:1447071253
Name:INFANT WELFARE SOCIETY OF CHICAGO
Entity type:Organization
Organization Name:INFANT WELFARE SOCIETY OF CHICAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-782-5034
Mailing Address - Street 1:3600 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2319
Mailing Address - Country:US
Mailing Address - Phone:773-782-2800
Mailing Address - Fax:773-782-5042
Practice Address - Street 1:6416 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3921
Practice Address - Country:US
Practice Address - Phone:773-782-2800
Practice Address - Fax:773-782-5042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFANT WELFARE SOCIETY OF CHICAGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-23
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)