Basic Information
| Provider Information | |||||||||
| NPI: | 1770818064 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIDWEST FAMILY AND COMMUNITY RESOURCES PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MFCR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3330 W 177TH ST | ||||||||
| Address2: | SUITE 1-F | ||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604292184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087453040 | ||||||||
| FaxNumber: | 7087991889 | ||||||||
| Practice Location | |||||||||
| Address1: | 3330 W 177TH ST | ||||||||
| Address2: | SUITE 1-F | ||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604292184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087453040 | ||||||||
| FaxNumber: | 7087991889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2009 | ||||||||
| LastUpdateDate: | 01/04/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | THURMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRERSIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 7087453040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MSW, LCSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 149007763 | IL | Y | Agencies | Community/Behavioral Health |
No ID Information.