NPIMap

Organization Active NPI

Friend Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1457525792
Registry record updated Sep 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FRIEND FAMILY HEALTH CENTER INC
Practice address
5635 S Pulaski Rd
Chicago, IL 60629-4438
Phone
(773) 702-0660
Fax
(773) 702-4356
NPI assigned
Apr 17, 2008
Last updated
Sep 14, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
FRIEND FAMILY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2012

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

Authorized official

Name
Sabrina Moore
Title
Cfo
Phone
(773) 702-5821

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5635 S Pulaski Rd
Chicago, IL 60629-4438

Mailing address

800 E 55TH St
Chicago, IL 60615-4906
Phone (773) 702-0660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040805001242 IL Part B Supplier - Clinic/Group Practice 2062494552 Receives reassigned benefits from 129 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL
O20120718000401 IL Part A Provider - Federally Qualified Health Center (FQHC) 2062494552 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457525792. Details of each certification follow.

Federally qualified health center certification: CCN 141180

Legal name
FRIEND FAMILY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 7, 2013
Last certification
Jan 7, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1997 in IL
Enrollment address
5635 S Pulaski Rd
Chicago, IL 60629-4438

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1091623Friend Health5635 S Pulaski Road, Chicago, IL 60629Certificate of waiverNov 4, 2026

National Provider Directory

National Provider Directory
Tax ID family
Friend Family Health Center- Beethoven9 organizations share this tax ID, including this one
Part of
Friend Family Health Center- Beethoven

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Judy Juarez Individual Corporate DirectorDirector/Officer Aug 23, 2024
Arshele Stevens Individual Corporate Officer Oct 1, 2016
Sean Harden Individual Corporate DirectorChairman Apr 1, 2006
Wendy Thompson Individual Corporate DirectorCeo Jun 30, 2024
W-2 Managing Employee Jun 30, 2024
Operational/Managerial ControlCeo Jun 30, 2024
Carlos Meyers Individual Corporate Officer Oct 1, 2013
Joanne Glenn Individual Corporate DirectorExecutive Board Member Oct 1, 2014
Maria McManus Individual Corporate Officer Oct 1, 2013
Ethel Hall-Langworthy Individual Corporate DirectorBoard Member Apr 1, 2005
Raheel Shahzad Individual Corporate OfficerCfo Aug 23, 2024
W-2 Managing EmployeeCfo Aug 23, 2024
Operational/Managerial ControlCfo Aug 23, 2024

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347580800000",
    "number": "1457525792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E 55TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154906",
            "telephone_number": "773-702-0660",
            "fax_number": "773-702-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5635 S PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606294438",
            "telephone_number": "773-702-0660",
            "fax_number": "773-702-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIEND FAMILY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRIEND FAMILY HEALTH CENTER",
        "enumeration_date": "2008-04-17",
        "last_updated": "2012-09-14",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "SABRINA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "773-702-5821"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.