Provider Demographics
NPI:1215343645
Name:ERIE FAMILY HEALTH
Entity type:Organization
Organization Name:ERIE FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR-BH
Authorized Official - Prefix:MS
Authorized Official - First Name:ALMUDENA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC, CADC
Authorized Official - Phone:312-432-7374
Mailing Address - Street 1:2750 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5247
Mailing Address - Country:US
Mailing Address - Phone:312-666-3494
Mailing Address - Fax:773-276-0749
Practice Address - Street 1:2750 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5247
Practice Address - Country:US
Practice Address - Phone:312-666-3494
Practice Address - Fax:773-276-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149013910251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health