Provider Demographics
NPI:1982870259
Name:COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Entity type:Organization
Organization Name:COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MPH
Authorized Official - Phone:312-795-0000
Mailing Address - Street 1:205 W RANDOLPH ST
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1867
Mailing Address - Country:US
Mailing Address - Phone:312-795-0000
Mailing Address - Fax:
Practice Address - Street 1:202 N SCHUYLER AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3833
Practice Address - Country:US
Practice Address - Phone:815-932-6045
Practice Address - Fax:815-932-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========013Medicaid