=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093394215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW CHOICE INTERVENTION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2021
-----------------------------------------------------
Last Update Date | 06/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142 E 154TH ST
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60426-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-566-1768
-----------------------------------------------------
Fax | 708-566-1786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142 E 154TH ST
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60426-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-566-1768
-----------------------------------------------------
Fax | 708-566-1786
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. TUNDE O ALI
-----------------------------------------------------
Credential | PHD, ACSW, QIDP, EIS
-----------------------------------------------------
Telephone | 708-566-1768
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3245S0500X
-----------------------------------------------------
Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------