Provider Demographics
NPI:1679330112
Name:FAMILY FIRST CENTER OF LAKE COUNTY
Entity type:Organization
Organization Name:FAMILY FIRST CENTER OF LAKE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-421-0948
Mailing Address - Street 1:2504 WASHINGTON ST STE 300N
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4983
Mailing Address - Country:US
Mailing Address - Phone:224-421-0948
Mailing Address - Fax:
Practice Address - Street 1:2504 WASHINGTON ST STE 300N
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4983
Practice Address - Country:US
Practice Address - Phone:224-421-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty