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14D1062402 CLIA NUMBER - SOUTH SUBURBAN COUNCIL ON ALCOHOLISM & SUBSTANCE

Laboratory Demographics

CLIA Number: 14D1062402

Facility Name: SOUTH SUBURBAN COUNCIL ON ALCOHOLISM & SUBSTANCE

Facility Address:
1909 CHEKER SQUARE
EAST HAZEL CREST, IL
ZIP 60429
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Facility Phone Number: 708 647-3333

Facility Type: Other

Certificate Type: Waiver
NPI Number: 1558362863

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
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.

CLIA Record

Field Name Field Value
CLIA Number 14D1062402
LAB Type Other
Facility Name SOUTH SUBURBAN COUNCIL ON ALCOHOLISM & SUBSTANCE
Street 1909 CHEKER SQUARE
City EAST HAZEL CREST
State IL
ZIP 60429
Phone 708 647-3333
CertificateType 4
CertificateEffectiveDate 12/13/2022
CertificateExpirationDate 12/12/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024