Provider Demographics
NPI:1326544735
Name:ICAN COMMUNITY SERVICES INC. NFP
Entity type:Organization
Organization Name:ICAN COMMUNITY SERVICES INC. NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUJIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH,CADC
Authorized Official - Phone:708-596-5680
Mailing Address - Street 1:15475 S PARK AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1377
Mailing Address - Country:US
Mailing Address - Phone:708-596-5680
Mailing Address - Fax:708-596-5687
Practice Address - Street 1:15475 S PARK AVE STE 109
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1377
Practice Address - Country:US
Practice Address - Phone:708-596-5680
Practice Address - Fax:708-596-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17009261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)