Basic Information
| Provider Information | |||||||||
| NPI: | 1659049518 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PILLARS COMMUNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N LA GRANGE RD | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605265646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089953598 | ||||||||
| FaxNumber: | 7089953568 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 E BURLINGTON ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605462146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087455277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2021 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | JANDA | ||||||||
| AuthorizedOfficialFirstName: | JEAN | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7089953598 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.