Healthcare Provider Details

I. General information

NPI: 1972752392
Provider Name (Legal Business Name): ELITE HOUSES OF SOBER LIVING,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W LINCOLN HWY
CHICAGO HEIGHTS IL
60411-2442
US

IV. Provider business mailing address

395 W LINCOLN HWY PO. BOX 2122
CHICAGO HEIGHTS IL
60411-2442
US

V. Phone/Fax

Practice location:
  • Phone: 708-755-5117
  • Fax: 708-755-5404
Mailing address:
  • Phone: 708-755-5117
  • Fax: 708-755-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-4780-00055-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License NumberA-4780-0005-A
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA-4780-0005-A
License Number StateIL

VIII. Authorized Official

Name: MR. ALBERT ELLIS III
Title or Position: PRESIDENT
Credential: CADC; NCRS;MISA 1
Phone: 312-515-3092