NPIMap

Organization Active NPI

Rincon Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
National Provider Identifier
1114505401
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
RINCON FAMILY SERVICES
Practice address
5457 W Diversey Ave
Chicago, IL 60639-1413
Phone
(773) 564-9070
NPI assigned
Mar 30, 2021
Last updated
Apr 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Pedro Perez, MBA
Title
Cfo
Phone
(773) 564-9070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

5457 W Diversey Ave
Chicago, IL 60639-1413

Mailing address

3942 W North Ave
Chicago, IL 60647-4639
Phone (773) 564-9070

Other identifiers 1

IdentifierTypeStateIssuer
14003MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Gateway

National Provider Directory

National Provider Directory
Tax ID family
Rincon Family Services21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

5457 W Diversey Ave
Chicago, IL 60639
Phone (773) 564-9070

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617667200000",
    "number": "1114505401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3942 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474639",
            "telephone_number": "773-564-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5457 W DIVERSEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391413",
            "telephone_number": "773-564-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RINCON FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "PEDRO",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "773-564-9070",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14003",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Gateway",
            "affiliation": "N",
            "address_1": "5457 W Diversey Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606391413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.