PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC NPI 1134553076

NPI Information

NPI: 1134553076
Provider Name: PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC

Doing Business As: PLCCA

Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

Address:
411 MADISON ST
MAYWOOD, IL
ZIP 60153
Phone: (708) 236-5042
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PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC is a methadone clinic center in Maywood, IL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC NPI is 1134553076. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Plcca.

The provider's business location address is:

411 MADISON ST
MAYWOOD, IL
ZIP 60153-136
Phone: (708) 236-5042

The provider's authorized official is Claude Porter .
The authorized official title is Ceo and has the following contact phone number (708) 450-3500.

The enumeration date for this NPI number is 8/28/2013 and was last updated on 3/20/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	No
2	261QM2800X	Clinic/Center	Methadone	Yes
3	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	No
4	276400000X	Rehabilitation, Substance Use Disorder Unit		No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1215987003	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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