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General NPI Number Information
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NPI Number | 1427592013
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Entity Type | Organization
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Legal Business Name | SPECIALIZED ASSISTANCE SERVICES, NFP
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 333 W EVERGREEN ST
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City | MANTENO
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State | IL
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Zip | 60950-9329
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Country | US
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Telephone | 815-468-6556
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Fax | 815-468-1098
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Provider Business Mailing Address
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Address Line | 2630 S WABASH AVE
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City | CHICAGO
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State | IL
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Zip | 60616-2825
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Country | US
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Telephone | 312-808-3218
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Fax | 312-791-9037
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MS. A. DORIS REYNOLDS
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Credential | JD
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Telephone | 312-808-3218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | A-0584-0002-A
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License Number State | IL
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