Provider Demographics
NPI:1679628143
Name:JAPANESE AMERICAN SERVICE COMMITTEE
Entity type:Organization
Organization Name:JAPANESE AMERICAN SERVICE COMMITTEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAKADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-275-0097
Mailing Address - Street 1:4427 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5403
Mailing Address - Country:US
Mailing Address - Phone:773-275-0097
Mailing Address - Fax:773-275-0958
Practice Address - Street 1:4427 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5403
Practice Address - Country:US
Practice Address - Phone:773-275-0097
Practice Address - Fax:773-275-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211164Medicare ID - Type Unspecified