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General NPI Number Information
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NPI Number | 1063361517
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Entity Type | Organization
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Legal Business Name | PROVISO PUBLIC PARTNERSHIP
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 2619 CONGRESS ST
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City | BELLWOOD
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State | IL
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Zip | 60104-2405
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Country | US
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Telephone | 708-240-4435
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Fax |
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Provider Business Mailing Address
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Address Line | 4565 HARRISON ST FL 3
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City | HILLSIDE
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State | IL
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Zip | 60162-1617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | KATHERINE WILLIAMS
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Credential |
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Telephone | 708-234-8661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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