NPIMap

Organization Active NPI

Pilsen-Little Village Community Mental Health Center, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Stone Park, IL
National Provider Identifier
1609054725
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC
Practice address
1546 N Mannheim Rd
Stone Park, IL 60165-1117
Phone
(708) 410-0856
Fax
(708) 410-0884
NPI assigned
Jan 31, 2008
Last updated
Feb 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Authorized official

Name
Mr. Francisco Cisneros, MA, CADC
Title
Executive Director
Phone
(773) 579-0832

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

1546 N Mannheim Rd
Stone Park, IL 60165-1117

Mailing address

2319 S Damen Ave
Chicago, IL 60608-4209
Phone (773) 579-0832

Other identifiers 2

IdentifierTypeStateIssuer
A-0155-0004-AOtherILSTATE GRANTS
A-0155-0004-AMedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Opioid treatment program
Medicare-enrolled since Mar 10, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200813000282 IL Part B Supplier - Opioid Treatment Program (Otp) 1355230020 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Stone Park, IL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Pilsen Wellness Center Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

1858 W Cermak Rd
Chicago, IL 60608
Phone (312) 226-1122

2015 W Cermak Rd
Chicago, IL 60608
Phone (773) 890-0645

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1609054725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2319 S DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606084209",
            "telephone_number": "773-579-0832",
            "fax_number": "773-579-0762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1546 N MANNHEIM RD",
            "city": "STONE PARK",
            "state": "IL",
            "postal_code": "601651117",
            "telephone_number": "708-410-0856",
            "fax_number": "708-410-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "CISNEROS",
        "authorized_official_first_name": "FRANCISCO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-579-0832",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, CADC"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE GRANTS",
            "identifier": "A-0155-0004-A",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A-0155-0004-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.