Provider Demographics
NPI:1912353962
Name:ACCESS COMMUNITY EXPERIENCE, INC.
Entity type:Organization
Organization Name:ACCESS COMMUNITY EXPERIENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MELAKU
Authorized Official - Middle Name:
Authorized Official - Last Name:TADESSE
Authorized Official - Suffix:
Authorized Official - Credentials:QIDP
Authorized Official - Phone:708-271-3463
Mailing Address - Street 1:4530 S WOODLAWN AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4487
Mailing Address - Country:US
Mailing Address - Phone:708-271-3463
Mailing Address - Fax:773-966-5437
Practice Address - Street 1:4530 S WOODLAWN AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4487
Practice Address - Country:US
Practice Address - Phone:708-271-3463
Practice Address - Fax:773-966-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201500011C320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities