Healthcare Provider Details

I. General information

NPI: 1255508941
Provider Name (Legal Business Name): ENHANCED CLINICAL SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S 1ST AVE SUITE# 310
MAYWOOD IL
60153-2442
US

IV. Provider business mailing address

1701 S 1ST AVE
MAYWOOD IL
60153-2442
US

V. Phone/Fax

Practice location:
  • Phone: 708-344-0884
  • Fax: 708-343-5629
Mailing address:
  • Phone: 708-344-0884
  • Fax: 708-343-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-4749-0001-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA-4749-0001-A
License Number StateIL

VIII. Authorized Official

Name: MR. FRANK MICHAEL JORDAN
Title or Position: PRESIDENT
Credential:
Phone: 708-344-0884