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SUNDANCE METHADONE TREATMENT CENTERLLC NPI 1316296007


NPI Information

NPI: 1316296007
Provider Name: SUNDANCE METHADONE TREATMENT CENTER,LLC
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

Address:
4545 N BROADWAY ST
3RD FLOOR
CHICAGO, IL
ZIP 60640
Phone: (773) 784-1111
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SUNDANCE METHADONE TREATMENT CENTER,LLC is a methadone clinic center in Chicago, 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. SUNDANCE METHADONE TREATMENT CENTER,LLC NPI is 1316296007. The provider is registered as an organization entity type.

The provider's business location address is:

4545 N BROADWAY ST
3RD FLOOR
CHICAGO, IL
ZIP 60640-975
Phone: (773) 784-1111
Fax: (773) 784-4910

The provider's authorized official is Tony P Woodard .
The authorized official title is Program Director and has the following contact phone number (773) 769-4545.

The enumeration date for this NPI number is 9/10/2012 and was last updated on 11/16/2021.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QR0400XClinic/CenterRehabilitationA31350001ILLINOISNo
2261QR0405XClinic/CenterRehabilitation, Substance Use DisorderA31350001ILLINOISNo
3276400000XRehabilitation, Substance Use Disorder UnitA31350001ILLINOISNo
4324500000XSubstance Abuse Rehabilitation FacilityA31350001ILLINOISNo
5261QM2800XClinic/CenterMethadoneYes

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: 11/14/2023

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