Pilsen Psychiatric Clinic & Associates LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

16001 Issued in IL

Legal business name

PILSEN PSYCHIATRIC CLINIC & ASSOCIATES LLC

Doing business as

Hope Community and Family Center of Chicago

Practice address

3350 S Kedzie Ave
Chicago, IL 60623-5114

Phone

(312) 564-5246

Fax

(312) 564-5253

NPI assigned

Apr 25, 2016

Last updated

Aug 31, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Krish Venoo, MD

Title

Owner

Phone

(312) 564-5246

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hope Community and Family Center of Chicago Doing business as

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

{
    "created_epoch": "1461542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1528413747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606235114",
            "telephone_number": "312-564-5246",
            "fax_number": "312-564-5253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606235114",
            "telephone_number": "312-564-5246",
            "fax_number": "312-564-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PILSEN PSYCHIATRIC CLINIC & ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-25",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "VENOO",
        "authorized_official_first_name": "KRISH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-564-5246",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "16001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "248000794",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hope Community and Family Center of Chicago",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pilsen Pharmacy
• Pilsen Psychiatric Clinic & Associates, LLC
• Pilsen-Little Village Community Mental Health Center, Inc (Pilsen Wellness Center Inc.)
• Pilsen-Little Village Community Mental Health Center, Inc (Pilsen Wellness Center Inc.)
• Pilsen-Little Village Community Mental Health Center, Inc (Pilsen Wellness Center, Inc.)
• Pilsen-Little Village Community Mental Health Center, Inc (Pilsen Wellness Center Inc.)

• Community/Behavioral Health Agency in Chicago, IL
• Providers in Chicago, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; 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.