Provider Demographics
NPI:1548975428
Name:SISTA AFYA COMMUNITY CARE NFP
Entity type:Organization
Organization Name:SISTA AFYA COMMUNITY CARE NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMESHA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:JONES BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:240-533-2876
Mailing Address - Street 1:5022 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-5328
Mailing Address - Country:US
Mailing Address - Phone:708-292-8730
Mailing Address - Fax:
Practice Address - Street 1:5022 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-5328
Practice Address - Country:US
Practice Address - Phone:708-292-8730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health