Provider Demographics
NPI:1962218834
Name:FEDERACION DE CLUBES MICHOACANOS EN ILLINOIS
Entity type:Organization
Organization Name:FEDERACION DE CLUBES MICHOACANOS EN ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARFIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-491-9317
Mailing Address - Street 1:1638 S BLUE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2134
Mailing Address - Country:US
Mailing Address - Phone:312-491-9317
Mailing Address - Fax:
Practice Address - Street 1:1638 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2134
Practice Address - Country:US
Practice Address - Phone:312-491-9317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251S00000XAgenciesCommunity/Behavioral Health