Provider Demographics
NPI:1386062214
Name:I AM ABLE CENTER FOR FAMILY DEVELOPMENT
Entity type:Organization
Organization Name:I AM ABLE CENTER FOR FAMILY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-826-2929
Mailing Address - Street 1:3408 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-4338
Mailing Address - Country:US
Mailing Address - Phone:773-826-2929
Mailing Address - Fax:773-826-2966
Practice Address - Street 1:3408 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4338
Practice Address - Country:US
Practice Address - Phone:773-826-2929
Practice Address - Fax:773-826-2966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I AM ABLE CENTER FOR FAMILY DEVELOPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-28
Last Update Date:2020-09-14
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
IL2A00-IPI-183Medicaid