| NPI | 1023286770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ULYSSES JEROME JEFFERSON Patient Revenue Coordinator 773-542-1150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 251S00000X Community/Behavioral Health (Licence: IL A-0579-0001-A) | |
| 261QM0801X (Licence: IL 16008) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-0579-001A) | |
| 276400000X Rehabilitation, Substance Use Disorder Unit (Licence: IL A-0579-0001-A) | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2022-12-20 |