Provider Demographics
NPI:1285892018
Name:ASSOCIATION HOUSE OF CHICAGO-DULCINEA
Entity type:Organization
Organization Name:ASSOCIATION HOUSE OF CHICAGO-DULCINEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:PHED
Authorized Official - Phone:773-772-8009
Mailing Address - Street 1:1116 N KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-4152
Mailing Address - Country:US
Mailing Address - Phone:773-772-8009
Mailing Address - Fax:773-292-5490
Practice Address - Street 1:3264 W CORTLAND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3758
Practice Address - Country:US
Practice Address - Phone:773-772-8009
Practice Address - Fax:773-292-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========011Medicaid