Friend Family Health Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Chicago, IL
NPI 1457525792 · NPPES record last updated Sep 14, 2012
Key facts
- NPI
- 1457525792
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- Yes
- Parent organization (as reported)
- FRIEND FAMILY HEALTH CENTER
Authorized official
- Name
- Sabrina Moore
- Title
- Cfo
- Phone
- (773) 702-5821
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 8
Practitioners 48
-
Samuel Logan, APN
-
Nakeisha Nicole Weathersby, CNM, APN
-
Zainab Abdul-Rahim, M.D.
-
Alma M Carlin, APN
-
Rashonda Collins, P.A.
-
Maribel Corral, PA-C
-
Danielle D Cox, LCSW
-
Tiffany Dean, DNP
-
Riskat Fadonougbo, PMHNP
-
Theresa A Flerick, N.P.
-
Fallon M Flowers, APRN, WHNP-BC
-
Geetha Govindarajan, M.D., PH.D., M.P.H
-
Gregory A Grubb, D.O.
-
April Annette Hamlet, APN
-
Bianca Jenkins, MD
-
Kimberly Knox, N.P.
-
Jean K Kombwa, APN
-
Andrea Loberg, M.D.
-
Tanvir Mushtaq, M.D.
-
Zachary Donald Nankee, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1091623 | Friend Health | Certificate of waiver | Nov 4, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
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
- Corporation · Non-profit
- Incorporated
- Jun 1, 1997 in IL
- Enrollment address
- 5635 S Pulaski Rd
Chicago, IL 60629-4438
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Judy Juarez |
Corporate Director |
Aug 23, 2024 | |
| Arshele Stevens |
Corporate Officer | Oct 1, 2016 | |
| Sean Harden |
Corporate Director |
Apr 1, 2006 | |
| Wendy Thompson |
Corporate Director |
Jun 30, 2024 | |
| W-2 Managing Employee | Jun 30, 2024 | ||
| Operational/Managerial Control |
Jun 30, 2024 | ||
| Carlos Meyers |
Corporate Officer | Oct 1, 2013 | |
| Joanne Glenn |
Corporate Director |
Oct 1, 2014 | |
| Maria McManus |
Corporate Officer | Oct 1, 2013 | |
| Ethel Hall-Langworthy |
Corporate Director |
Apr 1, 2005 | |
| Raheel Shahzad |
Corporate Officer |
Aug 23, 2024 | |
| W-2 Managing Employee |
Aug 23, 2024 | ||
| Operational/Managerial Control |
Aug 23, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Friend Family Health Center- Beethoven
- Part of
- Friend Family Health Center- Beethoven
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
Other providers in Chicago, IL
- Katherine J Friedmann
- Nora Friedmann
- William Joseph Friedrich
- Melanie Frieh
- Friend Family Health Center Inc
- Friend Family Health Center Inc
- Friend Family Health Center Inc
- Friend Family Health Center Inc
- Friend Family Health Center Inc
- Friend Family Health Center Inc
All providers in Chicago, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.