Basic Information
| Provider Information | |||||||||
| NPI: | 1467685669 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASIAN HUMAN SERVICES OF CHICAGO, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASIAN HUMAN SERVICES, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4753 N BROADWAY ST STE 700 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606404995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732938430 | ||||||||
| FaxNumber: | 7737284751 | ||||||||
| Practice Location | |||||||||
| Address1: | 1643 W BRYN MAWR AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606604106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734333530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2009 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | MAKI | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7732938468 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | A-5003-001-A | IL | N | Agencies | Community/Behavioral Health | 261QM0801X | A50030001A | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.