Provider Demographics
NPI:1063887107
Name:COMMUNITY DEVELOPMENT ENTERPRISES, INC
Entity type:Organization
Organization Name:COMMUNITY DEVELOPMENT ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:312-842-1229
Mailing Address - Street 1:79 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5520
Mailing Address - Country:US
Mailing Address - Phone:312-842-1229
Mailing Address - Fax:
Practice Address - Street 1:4740 183RD ST
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5212
Practice Address - Country:US
Practice Address - Phone:708-769-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH ELEMENTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4089-1003302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization