| NPI | 1316296007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY P WOODARD Program Director 773-769-4545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation (Licence: IL A31350001) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A31350001) | |
| 276400000X Rehabilitation, Substance Use Disorder Unit (Licence: IL A31350001) | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: IL A31350001) | |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2021-11-16 |