Healthcare Provider Details

I. General information

NPI: 1497272884
Provider Name (Legal Business Name): NEW HOPE COMMUNITY SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 W 79TH ST
CHICAGO IL
60652-1751
US

IV. Provider business mailing address

2559 W 79TH ST
CHICAGO IL
60652-1751
US

V. Phone/Fax

Practice location:
  • Phone: 773-737-9555
  • Fax: 773-737-0401
Mailing address:
  • Phone: 773-737-9555
  • Fax: 773-737-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA J GOLDEN
Title or Position: EXECUTIVE DIRECTOR
Credential: MHS/MAC/CAADC/MAATP
Phone: 773-737-9555