Provider Demographics
NPI:1053870204
Name:WILL COUNTY COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:WILL COUNTY COMMUNITY HEALTH CENTER
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:OLENEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-740-8982
Mailing Address - Street 1:5601 W MONEE MANHATTAN RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-8864
Mailing Address - Country:US
Mailing Address - Phone:815-727-8670
Mailing Address - Fax:815-846-8932
Practice Address - Street 1:5601 W MONEE MANHATTAN RD STE 109
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449-8864
Practice Address - Country:US
Practice Address - Phone:815-727-8670
Practice Address - Fax:815-846-8932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILL COUNTY COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
H80CS00476OtherHRSA GRANT NUMBER