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SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE NPI 1558362863


NPI Information

NPI: 1558362863
Provider Name: SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 14D1062402

Address:
1909 CHEKER SQ
EAST HAZEL CREST, IL
ZIP 60429
Phone: (708) 647-3333
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SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE is a substance abuse rehabilitation facility in East Hazel Crest, IL. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE NPI is 1558362863. The provider is registered as an organization entity type.

The provider's business location address is:

1909 CHEKER SQ
EAST HAZEL CREST, IL
ZIP 60429-442
Phone: (708) 647-3333
Fax: (708) 957-2614

The provider's authorized official is Allen Joseph Sandusky .
The authorized official title is President & Chief Executive Officer and has the following contact phone number (708) 647-3300.

The CLIA number assigned to this NPI record is 14D1062402 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/9/2005 and was last updated on 8/22/2020.


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 License Number License State Primary
1324500000XSubstance Abuse Rehabilitation FacilityA-0621-0001-AILLINOISYes

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: 5/5/2024

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