Provider Demographics
NPI:1902657919
Name:ACCESS COMMUNITY HEALTH NETWORK
Entity Type:Organization
Organization Name:ACCESS COMMUNITY HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-526-2279
Mailing Address - Street 1:600 W FULTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1262
Mailing Address - Country:US
Mailing Address - Phone:312-526-2411
Mailing Address - Fax:
Practice Address - Street 1:13000 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2318
Practice Address - Country:US
Practice Address - Phone:708-239-8095
Practice Address - Fax:978-577-5459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy